Provider Demographics
NPI:1154697357
Name:SOUTHEAST SURGICAL ASSISTANTS, LLC
Entity type:Organization
Organization Name:SOUTHEAST SURGICAL ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNSHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-650-7788
Mailing Address - Street 1:5008 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8231
Mailing Address - Country:US
Mailing Address - Phone:706-650-7788
Mailing Address - Fax:800-615-6836
Practice Address - Street 1:5008 SUSSEX DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8231
Practice Address - Country:US
Practice Address - Phone:706-650-7788
Practice Address - Fax:800-615-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty