Provider Demographics
NPI:1366898546
Name:SOUTHEAST SURGICAL ASSISTING, LLC
Entity type:Organization
Organization Name:SOUTHEAST SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARNER JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:770-596-1463
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-0055
Mailing Address - Country:US
Mailing Address - Phone:770-596-1463
Mailing Address - Fax:678-660-3201
Practice Address - Street 1:1062 GUM CREEK ROAD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-3000
Practice Address - Country:US
Practice Address - Phone:770-596-1463
Practice Address - Fax:678-660-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA165552363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty