Healthcare Provider Details

I. General information

NPI: 1497181572
Provider Name (Legal Business Name): NMDA CRNA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 MCGINNIS FERRY RD SUITE 102
ALPHARETTA GA
30005-3948
US

IV. Provider business mailing address

PO BOX 6377
WARNER ROBINS GA
31095-6377
US

V. Phone/Fax

Practice location:
  • Phone: 888-872-8088
  • Fax: 478-974-0110
Mailing address:
  • Phone: 866-458-0036
  • Fax: 478-974-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. JARED DERANEY
Title or Position: PRESIDENT
Credential: CRNA
Phone: 866-458-0036