Provider Demographics
NPI:1407371768
Name:PROLOGUE SURGICAL ASSISTING, LLC
Entity Type:Organization
Organization Name:PROLOGUE SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBAK
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:770-331-4217
Mailing Address - Street 1:3493 LOWER BURRIS RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4755
Mailing Address - Country:US
Mailing Address - Phone:770-331-4217
Mailing Address - Fax:
Practice Address - Street 1:3493 LOWER BURRIS RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-331-4217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty