Healthcare Provider Details

I. General information

NPI: 1649498064
Provider Name (Legal Business Name): PHYSICIANS FIRST ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 CROOKED CREEK ROAD SUITE 160
NORCROSS GA
30092
US

IV. Provider business mailing address

P.O. BOX 923821
NORCROSS GA
30010
US

V. Phone/Fax

Practice location:
  • Phone: 770-985-4257
  • Fax:
Mailing address:
  • Phone: 678-691-6529
  • Fax: 770-840-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN WALKER
Title or Position: CEO
Credential:
Phone: 678-691-6529