Provider Demographics
NPI:1376154229
Name:GRACED HANDS SURGICAL ASSISTING
Entity Type:Organization
Organization Name:GRACED HANDS SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:N
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:FIRST ASSIST
Authorized Official - Phone:334-714-0556
Mailing Address - Street 1:1320 CIMARRON PKWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6857
Mailing Address - Country:US
Mailing Address - Phone:334-714-0556
Mailing Address - Fax:
Practice Address - Street 1:1320 CIMARRON PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6857
Practice Address - Country:US
Practice Address - Phone:334-714-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty