Healthcare Provider Details

I. General information

NPI: 1407173891
Provider Name (Legal Business Name): DREAM WORK ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST STE 17
AUGUSTA GA
30901-2771
US

IV. Provider business mailing address

PO BOX 3023
EVANS GA
30809-0077
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-4111
  • Fax:
Mailing address:
  • Phone: 706-855-9860
  • Fax: 706-860-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LANCE HUDSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 706-855-9860