Provider Demographics
NPI:1710390356
Name:ACADEMY SURGICAL ASSISTANTS,LLC
Entity Type:Organization
Organization Name:ACADEMY SURGICAL ASSISTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-425-2480
Mailing Address - Street 1:PO BOX 28581
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30358-0581
Mailing Address - Country:US
Mailing Address - Phone:404-425-2480
Mailing Address - Fax:
Practice Address - Street 1:7225 NORTHGREEN DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1401
Practice Address - Country:US
Practice Address - Phone:404-425-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXSA00065284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes284300000XHospitalsSpecial Hospital
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty