MEDICARE: ABSOLUTE SURGICAL ASSISTANTS

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	163WR0006X	Registered Nurse First Assistant	RN195446	GA
2	363AS0400X	Surgical Physician Assistant
3	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1396105904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE SURGICAL ASSISTANTS

Provider Business Mailing Address
First Line	:	4653 POND LN
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4653 POND LN
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5618
Country	:	US
Telephone Number	:	770-330-5549
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHELLE LARUE
Credential	:
Telephone Number	:	770-330-5549

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/25/2016

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