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General NPI Number Information
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NPI Number | 1932577673
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Entity Type | Organization
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Legal Business Name | HIGHLAND SURGICAL ASSISTANT, LLC
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 11340 LAKEFIELD DR SUITE 200
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1714
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Country | US
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Telephone | 770-629-8289
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Fax | 404-393-9515
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Provider Business Mailing Address
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Address Line | 11340 LAKEFIELD DR SUITE 200
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1714
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Country | US
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Telephone | 770-629-8289
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Fax | 404-393-9515
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Authorized Official
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Title or Position | CEO
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Name | MR. WESLEY LAGREGORY MITCHELL JR.
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Credential |
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Telephone | 770-629-8289
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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 | 3245
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License Number State | GA
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