Terri Rybak, CST/CSFA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

3493 Lower Burris Rd
Canton, GA 30114-4755

Phone

(770) 331-4217

NPI assigned

Oct 4, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prologue Surgical Assisting, LLC

  • Surgical Physician Assistant
  • Canton, GA
  • NPI 1407371768

  Multi-Specialty

  NPD (past) Authorized official

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502150400000",
    "number": "1740599182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3493 LOWER BURRIS RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301144755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3493 LOWER BURRIS RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301144755",
            "telephone_number": "770-331-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYBAK",
        "first_name": "TERRI",
        "credential": "CST/CSFA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-04",
        "last_updated": "2017-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Rusher
• Andrea W. Russell, D.M.D.
• Carl M. Russell, DMD, PHD
• William Dirk Russell, D.M.D.
• James Michael Rutherford, CRNA
• Samuel M Sabaka, PH.D.
• Najam Sabreen, MD
• Jennifer-Linda S Saccoccia, MS, NCC, LAPC
• Giselle Sadeghi, DMD
• Sage Dental Group of Georgia, LLC (Sage Dental of Holly Springs)

• Surgical Physician Assistant in Canton, GA
• Providers in Canton, 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 Aug 8, 2017; 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.