Provider Demographics
NPI:1689550717
Name:TANZANITE SURGICAL ASSISTANTS, L.L.C.
Entity type:Organization
Organization Name:TANZANITE SURGICAL ASSISTANTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:501-765-8527
Mailing Address - Street 1:840 ERNEST W BARRETT PKWY NW UNIT 440204
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-0101
Mailing Address - Country:US
Mailing Address - Phone:501-765-8527
Mailing Address - Fax:
Practice Address - Street 1:840 ERNEST W BARRETT PKWY NW UNIT 440204
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30160-0101
Practice Address - Country:US
Practice Address - Phone:501-765-8527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty