Provider Demographics
NPI:1457403248
Name:PRIME SURGICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:PRIME SURGICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSA OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:770-559-8725
Mailing Address - Street 1:3180 N POINT PKWY
Mailing Address - Street 2:BULIDING 200 STE 207
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4248
Mailing Address - Country:US
Mailing Address - Phone:770-559-8725
Mailing Address - Fax:770-559-8276
Practice Address - Street 1:3180 NORTH POINT PARKWAY
Practice Address - Street 2:BULIDING 200 STE 207
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-559-8725
Practice Address - Fax:770-559-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty