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Organization
ICON SURGICAL
Active
Organization
ICON SURGICAL
Active
Other names
Icon Surgical
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA CLAY (ADMINISTRATOR)
(888) 265-9908
Entity
Organization
Contact information
Practice address
268 SAINT PATRICK DR SW, MABLETON, GA 30126-1627
(678) 825-5397
(678) 426-6243
Mailing address
268 SAINT PATRICK DR SW, MABLETON, GA 30126-1627
(678) 825-5397
(678) 426-6243
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
NULL
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
10/05/2021
Last updated
03/01/2024
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