Provider Demographics
NPI:1558507525
Name:PREFERRED SURGEON'S ASSISTANTS
Entity Type:Organization
Organization Name:PREFERRED SURGEON'S ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSA
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-309-4329
Mailing Address - Street 1:2483 HERITAGE VLG
Mailing Address - Street 2:SUITE 16 238
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6140
Mailing Address - Country:US
Mailing Address - Phone:770-979-5207
Mailing Address - Fax:770-979-5027
Practice Address - Street 1:2483 HERITAGE VLG
Practice Address - Street 2:SUITE 16 238
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6140
Practice Address - Country:US
Practice Address - Phone:770-979-5207
Practice Address - Fax:770-979-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
GA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty