Provider Demographics
NPI:1649497595
Name:PELICAN INC
Entity type:Organization
Organization Name:PELICAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASH
Authorized Official - Suffix:
Authorized Official - Credentials:RN-CSA, RRT, RN
Authorized Official - Phone:404-226-7769
Mailing Address - Street 1:3695 CASCADE RD SW STE F
Mailing Address - Street 2:#1102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2146
Mailing Address - Country:US
Mailing Address - Phone:404-226-7769
Mailing Address - Fax:770-907-6892
Practice Address - Street 1:3695 CASCADE RD SW STE F
Practice Address - Street 2:#1102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2146
Practice Address - Country:US
Practice Address - Phone:404-226-7769
Practice Address - Fax:770-907-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty