Provider Demographics
NPI:1174991269
Name:MIDTOWN SURGICAL ASSISTANTS
Entity type:Organization
Organization Name:MIDTOWN SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROYCE
Authorized Official - Middle Name:DUVALL
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:404-446-7169
Mailing Address - Street 1:11 CARRIAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6276
Mailing Address - Country:US
Mailing Address - Phone:404-446-7169
Mailing Address - Fax:
Practice Address - Street 1:11 CARRIAGE LAKE DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:404-446-7169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3225282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital