MEDICARE: NORTHSIDE CHEROKEE ANESTHESIA ASSOCIATES

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
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1356428304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE CHEROKEE ANESTHESIA ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 5448
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-0036
Country	:	US
Telephone Number	:	770-720-1063
Fax Number	:	770-720-4508

Provider Business Practice Location Address
First Line	:	220 HOSPITAL RD
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2407
Country	:	US
Telephone Number	:	770-479-2202
Fax Number	:	770-720-4508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. QUINTIN G GATES
Credential	:	MD
Telephone Number	:	770-720-1063

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/24/2010

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