Organization
NORTHEAST GEORGIA SURGICAL ASSISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENAH GALLAGHER CSFA (OWNER, INDEPENDENT CSFA)
(706) 870-1395
Entity
Organization
Contact information
Practice address
780 HAWKINS CREEK DR, JEFFERSON, GA 30549-5416
(706) 870-1395
Mailing address
780 HAWKINS CREEK DR, JEFFERSON, GA 30549-5416
(706) 870-1395
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
186361
CSFA CERTIFICATION NUMBER
GA
Enumeration date
01/15/2019
Last updated
01/15/2019
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