Healthcare Provider Details

I. General information

NPI: 1962883082
Provider Name (Legal Business Name): LOTUS SURGICAL ASSISTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW SUITE 280
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

PO BOX 931914
ATLANTA GA
31193-1914
US

V. Phone/Fax

Practice location:
  • Phone: 770-485-7628
  • Fax: 678-403-1081
Mailing address:
  • Phone: 706-660-8505
  • Fax: 706-660-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003278
License Number StateGA

VIII. Authorized Official

Name: MS. CATHERINE FRYSH
Title or Position: OWNER
Credential: PA
Phone: 770-485-7628