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General NPI Number Information
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NPI Number | 1205252285
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Entity Type | Organization
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Legal Business Name | SURGICHOICE SURGICAL, LLC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 6339 ANSLEY CIRCLE
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-4642
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Country | US
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Telephone | 470-385-2201
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Fax | 678-324-1439
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Provider Business Mailing Address
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Address Line | 6339 ANSLEY CIRCLE
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-4642
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Country | US
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Telephone | 470-385-2201
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Fax | 678-324-1439
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRANCE ALSHARRON JOHNSON
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Credential | CSFA/ CST
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Telephone | 470-385-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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