Healthcare Provider Details

I. General information

NPI: 1184786584
Provider Name (Legal Business Name): AXIS ANESTHESIA ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 NORTH AVE NE SUITE 100
ATLANTA GA
30308-2329
US

IV. Provider business mailing address

PO BOX 70243
MARIETTA GA
30007-0243
US

V. Phone/Fax

Practice location:
  • Phone: 770-459-3797
  • Fax:
Mailing address:
  • Phone: 770-578-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID BURNS
Title or Position: PRESIDENT
Credential: MD
Phone: 770-459-3797