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General NPI Number Information
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NPI Number | 1518199116
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Entity Type | Organization
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Legal Business Name | JACKSON SURGICAL ASSISTANTS, LLC
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 2655 NORTHWINDS PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2280
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Country | US
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Telephone | 404-434-6790
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Fax | 678-495-1385
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Provider Business Mailing Address
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Address Line | 2655 NORTHWINDS PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2280
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Country | US
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Telephone | 404-434-6790
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Fax | 678-495-1385
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL FOSTER
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Credential |
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Telephone | 404-434-6790
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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 |
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License Number State | GA
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