Healthcare Provider Details

I. General information

NPI: 1053467183
Provider Name (Legal Business Name): APEX SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DELK RD SE SUITE 700 RM 166
MARIETTA GA
30067-5320
US

IV. Provider business mailing address

2900 DELK RD SE SUITE 700 RM 166
MARIETTA GA
30067-5320
US

V. Phone/Fax

Practice location:
  • Phone: 770-509-9801
  • Fax:
Mailing address:
  • Phone: 770-509-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN E BOULLAIN
Title or Position: PRESIDENT AND CEO
Credential: RNFA
Phone: 770-509-9801