Provider Demographics
NPI:1982072609
Name:NWELITE SURGICAL LLC
Entity Type:Organization
Organization Name:NWELITE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED FIRST SURGICAL ASSIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-905-3089
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-0492
Mailing Address - Country:US
Mailing Address - Phone:770-905-3089
Mailing Address - Fax:770-675-3716
Practice Address - Street 1:2205 THICKET CT NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7955
Practice Address - Country:US
Practice Address - Phone:770-905-3089
Practice Address - Fax:770-675-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty