Healthcare Provider Details

I. General information

NPI: 1073886370
Provider Name (Legal Business Name): CHILDRENS ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2008
  • Fax: 404-785-4496
Mailing address:
  • Phone: 404-785-2008
  • Fax: 404-785-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN140297
License Number StateGA

VIII. Authorized Official

Name: MRS. PAULA WARREN FRIEDMAN
Title or Position: PEDIATRIC NURSE PRACTITIONER
Credential: CPNP
Phone: 404-785-5650