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General NPI Number Information
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NPI Number | 1649497595
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Entity Type | Organization
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Legal Business Name | PELICAN INC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 3695 CASCADE RD SW STE F #1102
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City | ATLANTA
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State | GA
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Zip | 30331-2146
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Country | US
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Telephone | 404-226-7769
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Fax | 770-907-6892
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Provider Business Mailing Address
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Address Line | 3695 CASCADE RD SW STE F #1102
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City | ATLANTA
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State | GA
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Zip | 30331-2146
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Country | US
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Telephone | 404-226-7769
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Fax | 770-907-6892
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN GASH
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Credential | RN-CSA, RRT, RN
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Telephone | 404-226-7769
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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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