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General NPI Number Information
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NPI Number | 1053488023
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Entity Type | Organization
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Legal Business Name | GEORGIA SURGICAL STAFFING, LLC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 78 DAWSON VILLAGE WAY N SUITE 140, PMB-13
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7168
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Country | US
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Telephone | 770-312-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 78 DAWSON VILLAGE WAY N SUITE 140, PMB-13
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7168
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Country | US
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Telephone | 770-312-0477
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALAN COUCH
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Credential | CRNFA
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Telephone | 770-312-0477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN054026
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License Number State | GA
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