Provider Demographics
NPI:1508579814
Name:SURGICAL OUTSOURCING LLC
Entity Type:Organization
Organization Name:SURGICAL OUTSOURCING LLC
Other - Org Name:SURGICAL OUTSOURCING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:QUADRENA
Authorized Official - Last Name:HARRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:404-380-0360
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:LOVEJOY
Mailing Address - State:GA
Mailing Address - Zip Code:30250-0471
Mailing Address - Country:US
Mailing Address - Phone:404-380-0360
Mailing Address - Fax:
Practice Address - Street 1:11565 CREEKSTONE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3467
Practice Address - Country:US
Practice Address - Phone:404-380-0360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty