MEDICARE: KANDER SURGICAL ASSISTING, 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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1912639147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANDER SURGICAL ASSISTING, LLC

Provider Business Mailing Address
First Line	:	950 EAGLES LANDING PKWY STE 246
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7343
Country	:	US
Telephone Number	:	762-215-5689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 GREEN ST SE #741
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012
Country	:	US
Telephone Number	:	762-215-5689
Fax Number	:

Authorized Official
Title or Position	:	CSA
Name	:	MRS. KIARA QUANTANEE' HUFF
Credential	:	CSA
Telephone Number	:	762-215-5689

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/24/2026

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