Healthcare Provider Details

I. General information

NPI: 1417977885
Provider Name (Legal Business Name): SURGICAL ASSISTANTS OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MCCLURE BRIDGE RD BUILDING B201
DULUTH GA
30096-6675
US

IV. Provider business mailing address

3400 MCCLURE BRIDGE RD BUILDING B201
DULUTH GA
30096-6675
US

V. Phone/Fax

Practice location:
  • Phone: 678-957-8801
  • Fax: 678-957-8804
Mailing address:
  • Phone: 678-957-8801
  • Fax: 678-957-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number058760
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number028757
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number015910
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003284
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004761
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number005133
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003653
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003394
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003970
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number000870
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004785
License Number StateGA
# 12
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004703
License Number StateGA
# 13
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number005631
License Number StateGA

VIII. Authorized Official

Name: MR. DAN CAVALLARO
Title or Position: CEO
Credential:
Phone: 678-957-8801