Provider Demographics
NPI:1376696153
Name:PRECISION SURGICAL ASSOCIATES OF ATLANTA
Entity Type:Organization
Organization Name:PRECISION SURGICAL ASSOCIATES OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-221-1095
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-221-1095
Mailing Address - Fax:404-221-1092
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-221-1095
Practice Address - Fax:404-221-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN
GA=========OtherEIN