MEDICARE: APEX SURGICAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant

General Provider Information

NPI Number	:	1053467183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX SURGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2900 DELK RD SE
Second Line	:	SUITE 700 RM 166
City	:	MARIETTA
State	:	GA
Zip	:	30067-5320
Country	:	US
Telephone Number	:	770-509-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 DELK RD SE
Second Line	:	SUITE 700 RM 166
City	:	MARIETTA
State	:	GA
Zip	:	30067-5320
Country	:	US
Telephone Number	:	770-509-9801
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	KAREN E BOULLAIN
Credential	:	RNFA
Telephone Number	:	770-509-9801

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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