Provider Demographics
NPI:1679010458
Name:SURGICAL ASSISTING BY CARMEN
Entity Type:Organization
Organization Name:SURGICAL ASSISTING BY CARMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSFA
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-789-3057
Mailing Address - Street 1:2095 HIGHWAY 211 NW # 147-2F
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3402
Mailing Address - Country:US
Mailing Address - Phone:678-789-3057
Mailing Address - Fax:
Practice Address - Street 1:2095 HIGHWAY 211 NW # 147-2F
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3402
Practice Address - Country:US
Practice Address - Phone:678-789-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty