Healthcare Provider Details

I. General information

NPI: 1124592746
Provider Name (Legal Business Name): DENMARK SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4271 WEAVERS WHITE LN
AUSTELL GA
30106-8256
US

IV. Provider business mailing address

PO BOX 4174
MARIETTA GA
30061-4174
US

V. Phone/Fax

Practice location:
  • Phone: 404-376-1712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: DANIA FERRER
Title or Position: SURGICAL ASSISTANT
Credential:
Phone: 404-376-1712