Surgivue First Assisting

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN183039 Issued in GA

Legal business name

SURGIVUE FIRST ASSISTING

Practice address

5865 Sinclair Way
Jonesboro, GA 30238

Phone

(770) 985-4257

Fax

(770) 985-4258

NPI assigned

Jul 17, 2015

Organization subpart

No

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

Authorized official

Name

Pam Phillip

Title

Credentialing Manager

Phone

(770) 985-4257

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1821472077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5865 SINCLAIR WAY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "30238",
            "telephone_number": "770-985-4257",
            "fax_number": "770-985-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5865 SINCLAIR WAY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "30238",
            "telephone_number": "770-985-4257",
            "fax_number": "770-985-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGIVUE FIRST ASSISTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "PHILLIP",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "770-985-4257"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN183039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; 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.