Healthcare Provider Details

I. General information

NPI: 1083946701
Provider Name (Legal Business Name): A SURGEON'S FIRST ASSISTANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 ANTLER CT
SUWANEE GA
30024-4114
US

IV. Provider business mailing address

PO BOX 3021
DULUTH GA
30096-0052
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
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00070
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1421
License Number StateGA

VIII. Authorized Official

Name: SCOT G FORTE
Title or Position: CEO
Credential:
Phone: 214-227-2457