Healthcare Provider Details

I. General information

NPI: 1447578497
Provider Name (Legal Business Name): MICHAEL J JANIK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 03/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-9860
  • Fax: 706-447-7111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN211817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: