Healthcare Provider Details

I. General information

NPI: 1972884229
Provider Name (Legal Business Name): ATLANTA SURGICAL ASSISTANT,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 ANGUS LEE DR
LAWRENCEVILLE GA
30045-2764
US

IV. Provider business mailing address

1840 ANGUS LEE DR
LAWRENCEVILLE GA
30045-2764
US

V. Phone/Fax

Practice location:
  • Phone: 404-931-1834
  • Fax:
Mailing address:
  • Phone: 404-931-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. TU OAI VU PHAM
Title or Position: DIRECTOR
Credential:
Phone: 404-931-1843