Healthcare Provider Details

I. General information

NPI: 1891005989
Provider Name (Legal Business Name): SWEET DREAMS NURSE ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 MCGINNIS FERRY RD STE 102
ALPHARETTA GA
30005-3901
US

IV. Provider business mailing address

PO BOX 850001 DEPT 0740
ORLANDO FL
32885-0740
US

V. Phone/Fax

Practice location:
  • Phone: 888-728-0882
  • Fax: 888-512-1507
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD DOUBERLY
Title or Position: MEMBER/MANAGER
Credential: CRNA
Phone: 888-728-0882