Healthcare Provider Details

I. General information

NPI: 1053488023
Provider Name (Legal Business Name): GEORGIA SURGICAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 DAWSON VILLAGE WAY N SUITE 140, PMB-13
DAWSONVILLE GA
30534-7168
US

IV. Provider business mailing address

78 DAWSON VILLAGE WAY N SUITE 140, PMB-13
DAWSONVILLE GA
30534-7168
US

V. Phone/Fax

Practice location:
  • Phone: 770-312-0477
  • Fax:
Mailing address:
  • Phone: 770-312-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN054026
License Number StateGA

VIII. Authorized Official

Name: MR. ALAN COUCH
Title or Position: PRESIDENT
Credential: CRNFA
Phone: 770-312-0477