Provider Demographics
NPI:1386813129
Name:ATLANTA SURGICAL 1ST ASSIST P.C.
Entity type:Organization
Organization Name:ATLANTA SURGICAL 1ST ASSIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:404-296-5005
Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-296-5005
Mailing Address - Fax:404-296-2070
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-296-5005
Practice Address - Fax:404-296-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN050722364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-SurgicalGroup - Single Specialty