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General NPI Number Information
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NPI Number | 1689550717
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Entity Type | Organization
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Legal Business Name | TANZANITE SURGICAL ASSISTANTS, L.L.C.
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 840 ERNEST W BARRETT PKWY NW UNIT 440204
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City | KENNESAW
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State | GA
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Zip | 30160-0101
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Country | US
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Telephone | 501-765-8527
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Fax |
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Provider Business Mailing Address
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Address Line | 840 ERNEST W BARRETT PKWY NW UNIT 440204
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City | KENNESAW
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State | GA
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Zip | 30160-0101
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Country | US
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Telephone | 501-765-8527
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARIEL V GILMORE
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Credential | SA
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Telephone | 501-765-8527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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