Organization
SURGIVUE FIRST ASSISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM PHILLIP (CREDENTIALING MANAGER)
(770) 985-4257
Entity
Organization
Contact information
Practice address
5865 SINCLAIR WAY, JONESBORO, GA 30238
(770) 985-4257
(770) 985-4258
Mailing address
5865 SINCLAIR WAY, JONESBORO, GA 30238
(770) 985-4257
(770) 985-4258
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN183039
GA
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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