Healthcare Provider Details

I. General information

NPI: 1235510595
Provider Name (Legal Business Name): SAGACITY SURGICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SANDY SPRINGS PL STE D-53
SANDY SPRINGS GA
30328-5918
US

IV. Provider business mailing address

227 SANDY SPRINGS PL STE D-53
SANDY SPRINGS GA
30328-5918
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 Number2748
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number86829
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number2748
License Number StateGA

VIII. Authorized Official

Name: EMMANUEL A RIVERS SR.
Title or Position: OWNER
Credential: CSA
Phone: 404-453-6757