Provider Demographics
NPI:1699024380
Name:JACKSON SURGICAL ASSISTANTS, LLC
Entity Type:Organization
Organization Name:JACKSON SURGICAL ASSISTANTS, LLC
Other - Org Name:JSA OF MARYLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-230-9617
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:ALPHARETTA
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0543
Mailing Address - Country:US
Mailing Address - Phone:877-230-9627
Mailing Address - Fax:
Practice Address - Street 1:2655 NORTHWINDS PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2280
Practice Address - Country:US
Practice Address - Phone:877-230-9617
Practice Address - Fax:877-281-8770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON SURGICAL ASSISTANTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-10
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty