Organization
SOUTHERN SURGICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN L JENSEN M.D. (PRESIDENT)
(770) 513-1763
Entity
Organization
Contact information
Practice address
743 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4317
(770) 513-1763
Mailing address
743 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4317
(770) 513-1763
(770) 513-2199
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP2433
MEDICARE GROUP NUMBER
GA
Enumeration date
11/15/2007
Last updated
05/03/2016
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