ICON SURGICAL
NPI 1255003455
Physician Assistant - Surgical in Mableton, GA

Q: What is Icon Surgical's NPI number?

The NPI number for Icon Surgical is 1255003455. It was assigned to this organization in the NPPES registry on October 5, 2021.

Q: What is Icon Surgical's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Icon Surgical was last updated on March 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 05, 2021

268 SAINT PATRICK DR SW, MABLETON, GA 30126(678) 825-5397(678) 426-6243 Get Directions Write a Review

NPPES record last updated: March 1, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About Icon Surgical NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ICON SURGICAL (NPI 1255003455) is a healthcare organization registered as a surgical in Mableton, Georgia and active in the NPI registry since October 2021. The organization lists Pamela Clay, Administrator, as its authorized official.

NPPES Registry Identity

NPI1255003455

Entity TypeOrganization

Primary Taxonomy363AS0400X

Legal Business NameICON SURGICAL

Location Address268 SAINT PATRICK DR SWMableton, GA 30126-1627

Mailing Address268 Saint Patrick Dr SwMableton, GA 30126-1627 · (678) 825-5397 · Fax (678) 426-6243

Phone(678) 825-5397

Fax(678) 426-6243

Organization SubpartNo

Authorized OfficialPamela ClayAdministrator · (888) 265-9908

Enumeration DateOctober 5, 2021

Last NPPES UpdateMarch 1, 2024

NPPES CertifiedMarch 1, 2024

✔ NPI 1255003455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

268 SAINT PATRICK DR SW, Mableton, GA 30126

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Other Names 1

Doing Business AsIcon Surgical

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Icon Surgical's NPI number?

The NPI number for Icon Surgical is 1255003455. It was assigned to this organization in the NPPES registry on October 5, 2021.

Where is Icon Surgical located?

Icon Surgical is located at 268 Saint Patrick Dr SW, Mableton, GA 30126. The listed phone number is (678) 825-5397.

What is Icon Surgical's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for Icon Surgical was last updated on March 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.