MEDICARE: SPECIFIED SOLUTIONS SURGICAL ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	2610	DC

General Provider Information

NPI Number	:	1255700092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIFIED SOLUTIONS SURGICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	207 ARABELLA PKWY
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-4250
Country	:	US
Telephone Number	:	404-932-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 FOSTER DR STE A
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5346
Country	:	US
Telephone Number	:	404-932-0295
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JERROD LAQUINTON WILLIAMS SR.
Credential	:	CSA
Telephone Number	:	404-932-0295

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	12/05/2025

Similar Medicare Providers

1528890696 — JONATHAN DAYNE MULLINAX PA-C
Practice Location Address:

156 FOSTER DR STE B
MCDONOUGH, GA
30253-5346

Practice Phone: 770-506-4119
Practice Fax: 770-506-4145

1063828416 — RHONDA RENEE JACKSON M.D.
Practice Location Address:

156 FOSTER DR SPC C
MCDONOUGH, GA
30253-5346

Practice Phone: 770-968-9978
Practice Fax: 770-968-9975

1346638905 — GABRIELLE N. BLAYLOCK PA-C, ATC
Practice Location Address:

156 FOSTER DR STE B
MCDONOUGH, GA
30253-5346

Practice Phone: 770-506-4119
Practice Fax:

1750963153 — MORGAN T STOKES PA
Practice Location Address:

156 FOSTER DR STE B
MCDONOUGH, GA
30253-5346

Practice Phone: 770-506-4119
Practice Fax: 770-506-4145

1982436382 — CAMERON ALEXANDER JOHNSON DPT
Practice Location Address:

156 FOSTER DR STE B
MCDONOUGH, GA
30253-5346

Practice Phone: 770-506-4119
Practice Fax:

1427583616 — MR. ANDREW M SCHULTZ FNP-C
Practice Location Address:

156 FOSTER DR STE B
MCDONOUGH, GA
30253-5330

Practice Phone: 770-506-4119
Practice Fax: 770-506-4145

Directions to “SPECIFIED SOLUTIONS SURGICAL ASSOCIATES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.