Northeast Ga Midlevel Services

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

4789 Issued in GA

Legal business name

NORTHEAST GA MIDLEVEL SERVICES

Practice address

43031 Parkside CT
Babcock Ranch, FL 33982-5065

Phone

(706) 338-3898

NPI assigned

Aug 25, 2013

Last updated

Sep 13, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Christine Ostroski, PA-C

Title

Owner

Phone

(706) 338-3898

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1377388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1811321011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43031 PARKSIDE CT",
            "city": "BABCOCK RANCH",
            "state": "FL",
            "postal_code": "339825065",
            "telephone_number": "706-338-3898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43031 PARKSIDE CT",
            "city": "BABCOCK RANCH",
            "state": "FL",
            "postal_code": "339825065",
            "telephone_number": "706-338-3898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Crane Mill Rd",
            "address_purpose": "LOCATION",
            "city": "Alto",
            "state": "GA",
            "postal_code": "305103621",
            "country_code": "US",
            "telephone_number": "706-338-3898",
            "fax_number": "888-353-8976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST GA MIDLEVEL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-25",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "OSTROSKI",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-338-3898",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "4789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Babcock Ranch, FL
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• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.