Healthcare Provider Details

I. General information

NPI: 1689550717
Provider Name (Legal Business Name): TANZANITE SURGICAL ASSISTANTS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 ERNEST W BARRETT PKWY NW UNIT 440204
KENNESAW GA
30160-0101
US

IV. Provider business mailing address

840 ERNEST W BARRETT PKWY NW UNIT 440204
KENNESAW GA
30160-0101
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-8527
  • Fax:
Mailing address:
  • Phone: 501-765-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: ARIEL V GILMORE
Title or Position: CEO
Credential: SA
Phone: 501-765-8527