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General NPI Number Information
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NPI Number | 1346420858
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGICAL SPECIALISTS OF NORTHEAST GEORGIA, LLC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 1359 MILSTEAD RD NE SUITE 203
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City | CONYERS
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State | GA
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Zip | 30012-3865
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Country | US
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Telephone | 678-413-2182
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Fax | 678-413-2184
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Provider Business Mailing Address
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Address Line | 1359 MILSTEAD RD NE SUITE 203
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City | CONYERS
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State | GA
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Zip | 30012-3865
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Country | US
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Telephone | 678-413-2182
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Fax | 678-413-2184
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Authorized Official
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Title or Position | OWNER, SOLE PROPRIETER
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Name | DR. KERMIE LENARD ROBINSON
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Credential | M.D., F.A.C.S.
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Telephone | 678-413-2182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 033440
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License Number State | GA
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