Healthcare Provider Details

I. General information

NPI: 1760404701
Provider Name (Legal Business Name): SURGICAL FIRST ASSISTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 HIGH ROCK TER
MARIETTA GA
30066-1606
US

IV. Provider business mailing address

4542 HIGH ROCK TER
MARIETTA GA
30066-1606
US

V. Phone/Fax

Practice location:
  • Phone: 678-488-7299
  • Fax: 770-578-8405
Mailing address:
  • Phone: 678-488-7299
  • Fax: 770-578-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN097274
License Number StateGA

VIII. Authorized Official

Name: MRS. SUSAN ULMER DEWOLF
Title or Position: PRESIDENT / CEO
Credential: CRNFA, NP-C
Phone: 678-488-7299