Provider Demographics
NPI:1285153171
Name:YOUR SURGICAL FIRST ASSISTANT
Entity type:Organization
Organization Name:YOUR SURGICAL FIRST ASSISTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBRETH
Authorized Official - Suffix:
Authorized Official - Credentials:CST,CSFA
Authorized Official - Phone:678-770-3700
Mailing Address - Street 1:345 CHARLYNE WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2381
Mailing Address - Country:US
Mailing Address - Phone:678-770-3700
Mailing Address - Fax:
Practice Address - Street 1:345 CHARLYNE WAY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019
Practice Address - Country:US
Practice Address - Phone:678-770-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTECHNOLOGIST