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General NPI Number Information
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NPI Number | 1972884229
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Entity Type | Organization
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Legal Business Name | ATLANTA SURGICAL ASSISTANT,LLC.
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1840 ANGUS LEE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2764
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Country | US
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Telephone | 404-931-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 ANGUS LEE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2764
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Country | US
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Telephone | 404-931-1834
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. TU OAI VU PHAM
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Credential |
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Telephone | 404-931-1843
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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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