Provider Demographics
NPI:1205252285
Name:SURGICHOICE SURGICAL, LLC
Entity type:Organization
Organization Name:SURGICHOICE SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:ALSHARRON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA/ CST
Authorized Official - Phone:470-385-2201
Mailing Address - Street 1:6339 ANSLEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-4642
Mailing Address - Country:US
Mailing Address - Phone:470-385-2201
Mailing Address - Fax:678-324-1439
Practice Address - Street 1:6339 ANSLEY CIRCLE
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-4642
Practice Address - Country:US
Practice Address - Phone:470-385-2201
Practice Address - Fax:678-324-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty