Healthcare Provider Details

I. General information

NPI: 1316968662
Provider Name (Legal Business Name): PHYSICIAN SPECIALISTS IN ANESTHESIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30342-1701
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD SUITE 610
ATLANTA GA
30342-5000
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-7324
  • Fax: 404-843-2627
Mailing address:
  • Phone: 404-257-1415
  • Fax: 404-851-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name: MELONY LYNN EPPS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 404-257-8603