Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgical |
363AS0400X | 97 | Physician Assistant | |
Medical-Surgical |
364SM0705X | 89 | Certified Clinical Nurse Specialist |
| NPI Number | 1861906083 |
| LBN Legal business name | GLEN CREEK SURGICAL PARTNERS, PLLC |
| Authorized official | ANDREW DOSSETT - (MANAGER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 11/27/2017 |
| Last updated | 09/07/2023 - About 3 years ago |
| Identifiers | n/a |