Healthcare Provider Details

I. General information

NPI: 1477833283
Provider Name (Legal Business Name): NORTH GEORGIA SURGICAL ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 SUNSET LN
WOODSTOCK GA
30189-7449
US

IV. Provider business mailing address

128 SUNSET LANE
WOODSTOCK GA
30189
US

V. Phone/Fax

Practice location:
  • Phone: 770-331-4217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TERRI MISKIEL
Title or Position: CERTIFIED SURGICAL FIRST ASSISTANT
Credential: CSFA
Phone: 770-331-4217