Organization · Type 2 NPI
Icon Surgical
Surgical Physician Assistant · Mableton, GA
NPI number
1255003455
Active
Practice location
268 Saint Patrick Dr SW
Mableton, GA 30126-1627
Fax (678) 426-6243
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgical Physician Assistant Primary | 363AS0400X | None listed |
Surgical Physician Assistant: Definition to come...
About NPI 1255003455
Icon Surgical's National Provider Identifier is 1255003455, issued on Oct 5, 2021. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Mableton, GA. The record was last updated on Mar 1, 2024.