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General NPI Number Information
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NPI Number | 1275064057
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Entity Type | Organization
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Legal Business Name | SURGICAL SERVICES OF AMERICA, PC
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 103 FORREST CROSSING BLVD STE 204
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City | FRANKLIN
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State | TN
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Zip | 37064-5453
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Country | US
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Telephone | 615-512-6136
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Fax | 615-591-5124
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Provider Business Mailing Address
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Address Line | 103 FORREST CROSSING BLVD STE 204
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City | FRANKLIN
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State | TN
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Zip | 37064-5453
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Country | US
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Telephone | 615-512-6136
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Fax | 615-591-5124
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BERNARD LERRIS BURGESS JR.
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Credential | M.D.
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Telephone | 615-512-6136
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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 | MD0000025546
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License Number State | TN
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