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General NPI Number Information
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NPI Number | 1750686150
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF GEORGIA
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 254 WADE ST NE
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City | ROME
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State | GA
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Zip | 30161-7047
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Country | US
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Telephone | 706-766-7851
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Fax |
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Provider Business Mailing Address
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Address Line | 254 WADE ST NE
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City | ROME
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State | GA
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Zip | 30161-7047
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Country | US
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Telephone | 706-766-7851
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JENNIFER LEE BRADEN
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Credential | CSFA
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Telephone | 706-766-7851
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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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