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NPI Code Detail

MEDICARE: SURGICAL FIRST ASSISTANTS, INC.

MEDICARE: SURGICAL FIRST ASSISTANTS, 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
1363LA2200XAdult Health Nurse PractitionerRN097274GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11518966175OTHERGANPI

General Provider Information

NPI Number : 1760404701
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURGICAL FIRST ASSISTANTS, INC.
Provider Business Mailing Address
First Line : 4542 HIGH ROCK TER
Second Line :
City : MARIETTA
State : GA
Zip : 30066-1606
Country : US
Telephone Number : 678-488-7299
Fax Number : 770-578-8405
Provider Business Practice Location Address
First Line : 4542 HIGH ROCK TER
Second Line :
City : MARIETTA
State : GA
Zip : 30066-1606
Country : US
Telephone Number : 678-488-7299
Fax Number : 770-578-8405
Authorized Official
Title or Position : PRESIDENT / CEO
Name : MRS. SUSAN ULMER DEWOLF
Credential : CRNFA, NP-C
Telephone Number : 678-488-7299
Provider Enumeration Date : 07/25/2006
Last Update Date : 08/22/2020

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