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General NPI Number Information
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NPI Number | 1235628256
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Entity Type | Organization
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Legal Business Name | MM SURGICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 930 NEW HOPE RD SUITE 11-526
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045
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Country | US
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Telephone | 404-921-4973
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Fax |
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Provider Business Mailing Address
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Address Line | 930 NEW HOPE RD SUITE 11-526
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045
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Country | US
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Telephone | 404-921-4973
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Fax |
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Authorized Official
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Title or Position | CSFA
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Name | MINELA MAHMUTOVIC
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Credential |
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Telephone | 404-921-4973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State | GA
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