Healthcare Provider Details

I. General information

NPI: 1376696153
Provider Name (Legal Business Name): PRECISION SURGICAL ASSOCIATES OF ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1110
ATLANTA GA
30308-2208
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1110
ATLANTA GA
30308-2208
US

V. Phone/Fax

Practice location:
  • Phone: 404-221-1095
  • Fax: 404-221-1092
Mailing address:
  • Phone: 404-221-1095
  • Fax: 404-221-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: TANIKA CROWTHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-221-1095