Healthcare Provider Details

I. General information

NPI: 1093035677
Provider Name (Legal Business Name): ANESTHESIA SOLUTIONS OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E MAIN ST STE 200
CANTON GA
30114-2784
US

IV. Provider business mailing address

PO BOX 4096
CANTON GA
30114-0217
US

V. Phone/Fax

Practice location:
  • Phone: 888-408-0200
  • Fax:
Mailing address:
  • Phone: 470-408-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY G BARTON
Title or Position: MEDICAL DIRECTOR
Credential: CRNA
Phone: 470-408-4437