Healthcare Provider Details

I. General information

NPI: 1518231414
Provider Name (Legal Business Name): FIRST CHOICE SURGICAL ASSISTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 VILLA CHASE DR NE
MARIETTA GA
30068-2040
US

IV. Provider business mailing address

PO BOX 681343
MARIETTA GA
30068-0023
US

V. Phone/Fax

Practice location:
  • Phone: 770-509-2309
  • Fax: 678-819-3928
Mailing address:
  • Phone: 770-509-2309
  • Fax: 678-819-3928

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: MELISSA MCMILLAN
Title or Position: CEO
Credential: CSA
Phone: 770-509-2309