Healthcare Provider Details

I. General information

NPI: 1386731453
Provider Name (Legal Business Name): SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 BLACKHAWK DR
GAINESVILLE GA
30506-2253
US

IV. Provider business mailing address

4117 BLACKHAWK DR
GAINESVILLE GA
30506-2253
US

V. Phone/Fax

Practice location:
  • Phone: 770-540-5163
  • Fax: 770-503-1784
Mailing address:
  • Phone: 770-540-5163
  • Fax: 770-503-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN073201
License Number StateGA

VIII. Authorized Official

Name: MARY MCCARTNEY MITCHELL
Title or Position: OWNER
Credential: RNFA
Phone: 770-540-5163