Provider Demographics
NPI: | 1639669880 |
---|---|
Name: | SOUTH ATLANTA SURGICAL ASSISTANTS |
Entity Type: | Organization |
Organization Name: | SOUTH ATLANTA SURGICAL ASSISTANTS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MARSHA |
Authorized Official - Middle Name: | TAYLOR |
Authorized Official - Last Name: | AYERS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RNFA |
Authorized Official - Phone: | 770-231-1598 |
Mailing Address - Street 1: | 824 MAPLE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | GRIFFIN |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30224-4919 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-231-1598 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1255 HIGHWAY 54 W |
Practice Address - Street 2: | |
Practice Address - City: | FAYETTEVILLE |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30214-4526 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-231-1598 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-05-14 |
Last Update Date: | 2018-05-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | RN069470 | 163W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Single Specialty |