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General NPI Number Information
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NPI Number | 1043775588
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Entity Type | Organization
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Legal Business Name | ELITESS SURGICAL SERVICE
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 245 N HIGHLAND AVE STE 230-451
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City | ATLANTA
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State | GA
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Zip | 30307-1936
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Country | US
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Telephone | 404-935-2189
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Fax | 888-265-5564
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Provider Business Mailing Address
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Address Line | 245 N HIGHLAND AVE STE 230-451
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City | ATLANTA
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State | GA
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Zip | 30307-1936
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Country | US
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Telephone | 404-935-2189
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Fax | 888-265-5564
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADAM SMART
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Credential | CSFA
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Telephone | 404-935-2189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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