Organization
PA-C SURGICAL ASSIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY GIBBERT PA (OWNER)
(404) 907-3292
Entity
Organization
Contact information
Practice address
520 W PONCE LEON AVE #1706, DECATUR, GA 30030
(404) 907-3292
Mailing address
PO BOX 1706, DECATUR, GA 30031-1706
(404) 907-3292
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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