Healthcare Provider Details

I. General information

NPI: 1881877793
Provider Name (Legal Business Name): ANESTHESIA CONSULTANTS OF AUGUSTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

PO BOX 204097
AUGUSTA GA
30917-4097
US

V. Phone/Fax

Practice location:
  • Phone: 706-466-4541
  • Fax: 706-650-1034
Mailing address:
  • Phone: 706-466-4541
  • Fax: 706-860-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: ALAN MILLEDGE SMITH
Title or Position: CEO
Credential:
Phone: 706-863-9595