Healthcare Provider Details

I. General information

NPI: 1134508666
Provider Name (Legal Business Name): 1ST ALLIANCE SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 JOHNSON FERRY RD SUITE # 140-145
ATLANTA GA
30342-1435
US

IV. Provider business mailing address

860 JOHNSON FERRY RD SUITE # 140-145
ATLANTA GA
30342-1435
US

V. Phone/Fax

Practice location:
  • Phone: 404-995-6754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: LIEFINA THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 404-995-6754