Provider Demographics
NPI:1760404701
Name:SURGICAL FIRST ASSISTANTS, INC.
Entity Type:Organization
Organization Name:SURGICAL FIRST ASSISTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ULMER
Authorized Official - Last Name:DEWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA, NP-C
Authorized Official - Phone:678-488-7299
Mailing Address - Street 1:4542 HIGH ROCK TER
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1606
Mailing Address - Country:US
Mailing Address - Phone:678-488-7299
Mailing Address - Fax:770-578-8405
Practice Address - Street 1:4542 HIGH ROCK TER
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1606
Practice Address - Country:US
Practice Address - Phone:678-488-7299
Practice Address - Fax:770-578-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097274363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1518966175OtherNPI
GAG8601Medicare UPIN