Healthcare Provider Details

I. General information

NPI: 1902494271
Provider Name (Legal Business Name): CLERK SURGICAL ASSISTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 HIGHWAY 34 E STE 1000
NEWNAN GA
30265-5631
US

IV. Provider business mailing address

1755 HIGHWAY 34 E STE 1000
NEWNAN GA
30265-5631
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WALTER LEE CLERK
Title or Position: OWNER
Credential: CSFA
Phone: 872-215-0850