Healthcare Provider Details

I. General information

NPI: 1518135946
Provider Name (Legal Business Name): SOUTHWEST GEORGIA ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PALMYRA RD
ALBANY GA
31701-1528
US

IV. Provider business mailing address

PO BOX 235019
MONTGOMERY AL
36123-5019
US

V. Phone/Fax

Practice location:
  • Phone: 229-438-8077
  • Fax:
Mailing address:
  • Phone: 800-232-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT B SPERRAZZA
Title or Position: PRESIDENT
Credential: MD
Phone: 22943907070