Healthcare Provider Details

I. General information

NPI: 1508915893
Provider Name (Legal Business Name): DEBORAH PRICE C.S.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY BUILDING 200 STE 207
ALPHARETTA GA
30005-4248
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: 770-553-8725
  • Fax: 770-559-8276
Mailing address:
  • Phone: 770-553-8725
  • Fax: 770-559-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number1266
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: