Provider Demographics
NPI:1720796980
Name:KELLERSURGICAL ASSISTING
Entity Type:Organization
Organization Name:KELLERSURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:770-940-0185
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-0009
Mailing Address - Country:US
Mailing Address - Phone:770-940-0185
Mailing Address - Fax:949-437-3333
Practice Address - Street 1:6144 STELLA LIGHT DR
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3451
Practice Address - Country:US
Practice Address - Phone:770-940-0185
Practice Address - Fax:949-437-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty