Healthcare Provider Details

I. General information

NPI: 1457403248
Provider Name (Legal Business Name): PRIME SURGICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 NORTH POINT PARKWAY BULIDING 200 STE 207
ALPHARETTA GA
30005
US

IV. Provider business mailing address

3180 N POINT PKWY BULIDING 200 STE 207
ALPHARETTA GA
30005-4248
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax: 770-559-8276
Mailing address:
  • Phone: 770-559-8725
  • Fax: 770-559-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH PRICE
Title or Position: CSA OWNER
Credential: CSA
Phone: 770-559-8725