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General NPI Number Information
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NPI Number | 1407371768
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Entity Type | Organization
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Legal Business Name | PROLOGUE SURGICAL ASSISTING, LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3493 LOWER BURRIS RD
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City | CANTON
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State | GA
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Zip | 30114
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Country | US
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Telephone | 770-331-4217
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Fax |
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Provider Business Mailing Address
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Address Line | 3493 LOWER BURRIS RD
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City | CANTON
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State | GA
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Zip | 30114-4755
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Country | US
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Telephone | 770-331-4217
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Fax |
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Authorized Official
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Title or Position | CERTIFIED SURGICAL FIRST ASSISTANT
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Name | TERRI RYBAK
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Credential | CSFA
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Telephone | 770-331-4217
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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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