Healthcare Provider Details

I. General information

NPI: 1942713326
Provider Name (Legal Business Name): SOUTHCARE ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 MEDICAL PARK DR STE 300
AUSTELL GA
30106-6831
US

IV. Provider business mailing address

PO BOX 673
AUSTELL GA
30168-1007
US

V. Phone/Fax

Practice location:
  • Phone: 770-941-4810
  • Fax: 770-948-9149
Mailing address:
  • Phone: 770-941-4810
  • Fax: 770-948-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASMINE JEFFERS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 770-941-4810