MEDICARE: MIDTOWN 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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1386793180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN SURGICAL ASSOCIATES,INC

Provider Business Mailing Address
First Line	:	308 WYNGATE RD
Second Line	:
City	:	AUBURN
State	:	GA
Zip	:	30011-2930
Country	:	US
Telephone Number	:	404-210-1033
Fax Number	:	770-963-4890

Provider Business Practice Location Address
First Line	:	308 WYNGATE RD
Second Line	:
City	:	AUBURN
State	:	GA
Zip	:	30011-2930
Country	:	US
Telephone Number	:	404-210-1033
Fax Number	:	770-963-4890

Authorized Official
Title or Position	:	SURGICAL ASST.
Name	:	MR. ROBERT G MERCER
Credential	:	CFA
Telephone Number	:	404-210-1033

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/22/2020

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