Provider Demographics
NPI:1316257041
Name:SOUTHERN CRESCENT SURGICAL ASSISTING P C
Entity type:Organization
Organization Name:SOUTHERN CRESCENT SURGICAL ASSISTING P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-408-8696
Mailing Address - Street 1:798 MALLERY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-4021
Mailing Address - Country:US
Mailing Address - Phone:404-408-8696
Mailing Address - Fax:
Practice Address - Street 1:798 MALLERY ST APT 2
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4021
Practice Address - Country:US
Practice Address - Phone:404-408-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN096995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty