MEDICARE: SURGICAL OUTSOURCING LLC

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

General Provider Information

NPI Number	:	1508579814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL OUTSOURCING LLC

Provider Business Mailing Address
First Line	:	11565 CREEKSTONE RD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3467
Country	:	US
Telephone Number	:	404-380-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	11565 CREEKSTONE RD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3467
Country	:	US
Telephone Number	:	404-380-0360
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. AMY QUADRENA HARRIEL
Credential	:	CSFA
Telephone Number	:	404-380-0360

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	01/08/2026

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Directions to “SURGICAL OUTSOURCING LLC ” Practice Location

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