Provider Demographics
NPI:1497410104
Name:COUSIN SURGICAL SERVICES, L.L.C.
Entity Type:Organization
Organization Name:COUSIN SURGICAL SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:HERB
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:762-235-4343
Mailing Address - Street 1:2537 CEDARCREST RD STE 305-63
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8900
Mailing Address - Country:US
Mailing Address - Phone:762-235-4343
Mailing Address - Fax:
Practice Address - Street 1:2537 CEDARCREST RD STE 305-63
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8900
Practice Address - Country:US
Practice Address - Phone:762-235-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty