Healthcare Provider Details

I. General information

NPI: 1063959872
Provider Name (Legal Business Name): AMY MORALES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 BAXTER ST
ATHENS GA
30606-3712
US

IV. Provider business mailing address

PO BOX 3204
INDIANAPOLIS IN
46206-3204
US

V. Phone/Fax

Practice location:
  • Phone: 706-227-3450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN209684
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: