Healthcare Provider Details

I. General information

NPI: 1184535635
Provider Name (Legal Business Name): LEVESQUE'S SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LAKE HEARN DR NE APT 4507
BROOKHAVEN GA
30319-1867
US

IV. Provider business mailing address

1400 LAKE HEARN DR NE APT 4507
BROOKHAVEN GA
30319-1867
US

V. Phone/Fax

Practice location:
  • Phone: 678-592-2812
  • Fax:
Mailing address:
  • Phone: 678-592-2812
  • 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: ELIJAH MICHAEL LEVESQUE
Title or Position: OWNER
Credential: CSFA
Phone: 678-592-2812