MEDICARE: SUPERIOR 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	211D00000X	Podiatric Assistant

General Provider Information

NPI Number	:	1417248907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR SURGICAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	5881 GLENRIDGE DR NE
Second Line	:	SUITE 120
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-303-7703
Fax Number	:	404-303-7706

Provider Business Practice Location Address
First Line	:	5881 GLENRIDGE DR NE
Second Line	:	SUITE 120
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-303-7703
Fax Number	:	404-303-7706

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	VANETTA LOCKETT
Credential	:
Telephone Number	:	404-303-7703

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	08/20/2013

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