Basic Information
| Provider Information | |||||||||
| NPI: | 1962883082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOTUS SURGICAL ASSISTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 931914 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311931914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066608505 | ||||||||
| FaxNumber: | 7066601454 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 CAMPBELL HILL ST NW | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704857628 | ||||||||
| FaxNumber: | 6784031081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | FRYSH | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7704857628 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 003278 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.