Eastside Surgical Assistants LLC

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

Legal business name

EASTSIDE SURGICAL ASSISTANTS LLC

Practice address

925 Main St
Suite 300-07
Stone Mountain, GA 30083-3098

Phone

(678) 799-2498

NPI assigned

Sep 30, 2015

Last updated

Sep 30, 2015By 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

Mr. Samuel FendersonNPI 1326370545

Title

Certified Surgical Assistant

Phone

(678) 799-2498

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel Fenderson

  • Surgical Physician Assistant
  • Stone Mountain, GA
  • NPI 1326370545
  Authorized official Same address or phone

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

{
    "created_epoch": "1443571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443571200000",
    "number": "1962872218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 MAIN ST",
            "address_2": "SUITE 300-07",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833098",
            "telephone_number": "678-799-2498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 MAIN ST",
            "address_2": "SUITE 300-07",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833098",
            "telephone_number": "678-799-2498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE SURGICAL ASSISTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-30",
        "last_updated": "2015-09-30",
        "status": "A",
        "authorized_official_last_name": "FENDERSON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CERTIFIED SURGICAL ASSISTANT",
        "authorized_official_telephone_number": "678-799-2498",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Assistant in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Surgical Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.