Healthcare Provider Details

I. General information

NPI: 1609593326
Provider Name (Legal Business Name): GREATER GAINESVILLE ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SW PROSPERITY PL
LAKE CITY FL
32024-0684
US

IV. Provider business mailing address

3414 PEACHTREE RD NE STE 340
ATLANTA GA
30326-1137
US

V. Phone/Fax

Practice location:
  • Phone: 386-487-3930
  • Fax: 866-665-8561
Mailing address:
  • Phone: 425-803-3885
  • Fax: 866-665-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JEFF PERRY
Title or Position: VP OF RCM
Credential:
Phone: 502-418-4700