Healthcare Provider Details

I. General information

NPI: 1750740684
Provider Name (Legal Business Name): SURGICAL ASSISTANT COUNSULTING OF GEORGIA L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2016
Last Update Date: 02/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 DALLAS HWY STE 200-224
POWDER SPRINGS GA
30127-6318
US

IV. Provider business mailing address

5200 DALLAS HWY STE 200-224
POWDER SPRINGS GA
30127-6318
US

V. Phone/Fax

Practice location:
  • Phone: 770-687-9596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN220938
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KEVIN JABLONSKY
Title or Position: RNFA
Credential: RNFA
Phone: 205-250-9966