MEDICARE: NORTHWEST ALLIED ANESTHESIA INC.

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	:	1639466980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST ALLIED ANESTHESIA INC.

Provider Business Mailing Address
First Line	:	6255 BARFIELD RD NE
Second Line	:	SUITE 175
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4319
Country	:	US
Telephone Number	:	404-255-1846
Fax Number	:	404-255-1831

Provider Business Practice Location Address
First Line	:	6255 BARFIELD RD NE
Second Line	:	SUITE 175
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4319
Country	:	US
Telephone Number	:	404-255-1846
Fax Number	:	404-255-1831

Authorized Official
Title or Position	:	SECRETARY
Name	:	MARY ELLEN HARRIS
Credential	:
Telephone Number	:	404-255-1846

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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