Provider Demographics
NPI:1932577673
Name:HIGHLAND SURGICAL ASSISTANT, LLC
Entity Type:Organization
Organization Name:HIGHLAND SURGICAL ASSISTANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:LAGREGORY
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-629-8289
Mailing Address - Street 1:11340 LAKEFIELD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1714
Mailing Address - Country:US
Mailing Address - Phone:770-629-8289
Mailing Address - Fax:404-393-9515
Practice Address - Street 1:11340 LAKEFIELD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1714
Practice Address - Country:US
Practice Address - Phone:770-629-8289
Practice Address - Fax:404-393-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3245363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty