Icon Surgical

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

ICON SURGICAL

Practice address

268 Saint Patrick Dr SW
Mableton, GA 30126-1627

Phone

(678) 825-5397

Fax

(678) 426-6243

NPI assigned

Oct 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Pamela Clay

Title

Administrator

Phone

(888) 265-9908

Specialties & licenses 1

Addresses

Other names 1

• Icon Surgical Doing business as

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick Lee Pearson Jr., CSFA

  • Physician Assistant
  • Locust Grove, GA
  • NPI 1508601675
  NPD
• Adam Smart, CSA

  • Surgical Physician Assistant
  • Atlanta, GA
  • NPI 1093816704

  Multi-Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1255003455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 SAINT PATRICK DR SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261627",
            "telephone_number": "678-825-5397",
            "fax_number": "678-426-6243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "268 SAINT PATRICK DR SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261627",
            "telephone_number": "678-825-5397",
            "fax_number": "678-426-6243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON SURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "CLAY",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "888-265-9908",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "billing@iconsurgicalatl.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "268 Saint Patrick Dr SW",
            "city": "Mableton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301261627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Icon Surgical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Icon Surgical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Surgical Physician Assistant in Mableton, GA
• Providers in Mableton, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.