Healthcare Provider Details

I. General information

NPI: 1972638047
Provider Name (Legal Business Name): AHP OF CENTRAL GEORGIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 4075
ATLANTA GA
30309-1751
US

IV. Provider business mailing address

DEPT 40157 PO BOX 740209
ATLANTA GA
30374-0209
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SEAN LYNCH
Title or Position: PRESIDENT
Credential:
Phone: 770-945-5330