Healthcare Provider Details

I. General information

NPI: 1053550418
Provider Name (Legal Business Name): VIGILANT ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HAWKS LAKE DR
BALL GROUND GA
30107-6445
US

IV. Provider business mailing address

220 HAWKS LAKE DR
BALL GROUND GA
30107-6445
US

V. Phone/Fax

Practice location:
  • Phone: 770-712-3892
  • Fax:
Mailing address:
  • Phone: 770-712-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number44448
License Number StateGA

VIII. Authorized Official

Name: DR. CLARKSON M DRIGGERS
Title or Position: OWNER
Credential: M.D.
Phone: 770-712-3892