Provider Demographics
NPI:1417977885
Name:SURGICAL ASSISTANTS OF AMERICA, INC.
Entity Type:Organization
Organization Name:SURGICAL ASSISTANTS OF AMERICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-957-8801
Mailing Address - Street 1:3400 MCCLURE BRIDGE RD
Mailing Address - Street 2:BUILDING B201
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6675
Mailing Address - Country:US
Mailing Address - Phone:678-957-8801
Mailing Address - Fax:678-957-8804
Practice Address - Street 1:3400 MCCLURE BRIDGE RD
Practice Address - Street 2:BUILDING B201
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6675
Practice Address - Country:US
Practice Address - Phone:678-957-8801
Practice Address - Fax:678-957-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058760208600000X
GA028757208600000X
GA015910208600000X
GA003284363AS0400X
GA004761363AS0400X
GA005133363AS0400X
GA003653363AS0400X
GA003394363AS0400X
GA003970363AS0400X
GA000870363AS0400X
GA004785363AS0400X
GA004703363AS0400X
GA005631363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1417977885Medicaid
GA1417977885OtherBCBS
GAGRP4210Medicare PIN