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General NPI Number Information
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NPI Number | 1316257041
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Entity Type | Organization
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Legal Business Name | SOUTHERN CRESCENT SURGICAL ASSISTING P C
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 798 MALLERY ST APT 2
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-4021
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Country | US
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Telephone | 404-408-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 798 MALLERY ST APT 2
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-4021
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Country | US
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Telephone | 404-408-8696
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANGELA C BARNARD
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Credential | FNP
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Telephone | 404-408-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN096995
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License Number State | GA
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