Healthcare Provider Details

I. General information

NPI: 1851799373
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 TARA TRL
ATLANTA GA
30327-4926
US

IV. Provider business mailing address

PO BOX 76295
ATLANTA GA
30358-1295
US

V. Phone/Fax

Practice location:
  • Phone: 404-242-6360
  • Fax: 404-549-2853
Mailing address:
  • Phone: 404-242-6360
  • Fax: 404-549-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number039201
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number039201
License Number StateGA

VIII. Authorized Official

Name: DR. STANFORD R PLAVIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 404-242-6360