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General NPI Number Information
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NPI Number | 1679010458
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSISTING BY CARMEN
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 2095 HIGHWAY 211 NW # 147-2F
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City | BRASELTON
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State | GA
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Zip | 30517-3402
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Country | US
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Telephone | 678-789-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 2095 HIGHWAY 211 NW # 147-2F
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City | BRASELTON
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State | GA
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Zip | 30517-3402
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Country | US
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Telephone | 678-789-3057
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Fax |
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Authorized Official
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Title or Position | CSFA
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Name | CARMEN WAUGH
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Credential |
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Telephone | 678-789-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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