Provider Demographics
NPI:1851772404
Name:SURGICAL ASSISTANT SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SURGICAL ASSISTANT SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:KISTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:404-636-0096
Mailing Address - Street 1:3522 ASHFORD DUNWOODY RD NE # 141
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2002
Mailing Address - Country:US
Mailing Address - Phone:404-636-0096
Mailing Address - Fax:
Practice Address - Street 1:3522 ASHFORD DUNWOODY RD NE # 141
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2002
Practice Address - Country:US
Practice Address - Phone:404-636-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA195446163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty