Healthcare Provider Details

I. General information

NPI: 1033824032
Provider Name (Legal Business Name): PRECISION SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MARGOT ST APT 2406
LAWRENCEVILLE GA
30043-9519
US

IV. Provider business mailing address

PO BOX 1104
GRAYSON GA
30017-0022
US

V. Phone/Fax

Practice location:
  • Phone: 678-294-9735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LINDSY M VARGAS GUEVARA
Title or Position: OWNER
Credential:
Phone: 678-294-9735