Healthcare Provider Details

I. General information

NPI: 1467445262
Provider Name (Legal Business Name): NORTH FULTON ANESTHESIA ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 PEACHTREE DUNWOODY RD STE B110
ATLANTA GA
30328-5911
US

IV. Provider business mailing address

PO BOX 106086
ATLANTA GA
30348-6086
US

V. Phone/Fax

Practice location:
  • Phone: 770-551-9944
  • Fax:
Mailing address:
  • Phone: 470-308-4905
  • Fax:

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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name: BRADLEY SCOTT DOWLING
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 470-308-4905