Provider Demographics
NPI:1801289541
Name:PARTNERS MEDICAL & SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PARTNERS MEDICAL & SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:770-865-9023
Mailing Address - Street 1:2221 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 471D
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1148
Mailing Address - Country:US
Mailing Address - Phone:770-865-9023
Mailing Address - Fax:
Practice Address - Street 1:2221 PEACHTREE RD NE
Practice Address - Street 2:SUITE 471D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1148
Practice Address - Country:US
Practice Address - Phone:770-865-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005514363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty