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General NPI Number Information
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NPI Number | 1548000813
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Entity Type | Organization
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Legal Business Name | CHIEF SURGICAL, L.L.C.
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Dates
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Enumeration Date | 05/25/2024
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Last Update Date | 05/25/2024
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Provider Practice Location Address
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Address Line | 80 SEVEN HILLS BLVD STE 101-373
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City | DALLAS
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State | GA
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Zip | 30132-0574
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Country | US
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Telephone | 762-235-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 80 SEVEN HILLS BLVD STE 101-373
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City | DALLAS
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State | GA
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Zip | 30132-0574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HERBERT COUSIN JR.
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Credential | CSA
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Telephone | 762-235-4343
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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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