Provider Demographics
NPI:1740528934
Name:PRIMA AMBULATORY SURGICAL SERVICES
Entity type:Organization
Organization Name:PRIMA AMBULATORY SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWIREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-495-1477
Mailing Address - Street 1:3096 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3096 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7918
Practice Address - Country:US
Practice Address - Phone:770-495-1477
Practice Address - Fax:770-495-1488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMA CENTER FOR PLASTIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical