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General NPI Number Information
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NPI Number | 1801289541
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Entity Type | Organization
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Legal Business Name | PARTNERS MEDICAL & SURGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 2221 PEACHTREE RD NE SUITE 471D
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 770-865-9023
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 PEACHTREE RD NE SUITE 471D
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 770-865-9023
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | CHANTEL LEE
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Credential | PA
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Telephone | 770-865-9023
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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 | 005514
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License Number State | GA
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