Organization
SOUTHERN SURGICAL ASSISTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH KANCLERZ RNFA (CEO)
(678) 591-8344
Entity
Organization
Contact information
Practice address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3200
Mailing address
PO BOX 7042, CHESTNUT MOUNTAIN, GA 30502-0042
(678) 591-8344
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN177592
GA
Other
Enumeration date
11/16/2011
Last updated
09/17/2015
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