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NPI Code Detail

MEDICARE: MIDTOWN UROLOGY ANESTHESIA LLC

MEDICARE: MIDTOWN UROLOGY ANESTHESIA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1154102598
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDTOWN UROLOGY ANESTHESIA LLC
Provider Business Mailing Address
First Line : 2625 PIEDMONT RD NE STE 56-671
Second Line :
City : ATLANTA
State : GA
Zip : 30324-3086
Country : US
Telephone Number : 678-592-8724
Fax Number :
Provider Business Practice Location Address
First Line : 1924 PIEDMONT RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30324-4117
Country : US
Telephone Number : 678-592-8724
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. JENELLE FOOTE
Credential : MD
Telephone Number : 678-592-8724
Provider Enumeration Date : 10/11/2023
Last Update Date : 11/28/2023

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Directions to “MIDTOWN UROLOGY ANESTHESIA LLC ” Practice Location

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