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General NPI Number Information
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NPI Number | 1912315763
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Entity Type | Organization
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Legal Business Name | SPECTRUM SURGICAL ASSISTING LLC
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 146 MARTIN LUTHER KING JR BLVD #302
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City | MONROE
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State | GA
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Zip | 30655
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Country | US
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Telephone | 386-479-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 146 MARTIN LUTHER KING JR BLVD #302
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City | MONROE
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State | GA
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Zip | 30655
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Country | US
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Telephone | 386-479-9575
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED CSA
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Name | MR. FRANK PAUL TANNER
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Credential | LCSA
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Telephone | 386-960-4534
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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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