Healthcare Provider Details

I. General information

NPI: 1659632800
Provider Name (Legal Business Name): BNN STRATEGIC MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD NE SUITE 680
ATLANTA GA
30342-5000
US

IV. Provider business mailing address

PO BOX 864827
ORLANDO FL
32886-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-705-6985
  • Fax: 404-851-9950
Mailing address:
  • Phone: 888-337-3509
  • Fax: 941-328-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL R NOBACK
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 888-337-3509