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General NPI Number Information
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NPI Number | 1639354996
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Entity Type | Organization
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Legal Business Name | PHILEMON SURGICAL ASSOCIATES INC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 622 PENNYLAKE LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5768
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Country | US
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Telephone | 770-761-9508
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 839
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City | STONE MOUNTAIN
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State | GA
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Zip | 30086-0839
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Country | US
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Telephone | 770-761-9508
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN LEWIS THOMPSON
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Credential | CSA
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Telephone | 770-761-9508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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