Healthcare Provider Details

I. General information

NPI: 1699668780
Provider Name (Legal Business Name): ALEXIS SERES RN, BSN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS LOVIN RN, BSN, CCRN

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 OLD MAGNOLIA TRL
CANTON GA
30115-7979
US

IV. Provider business mailing address

597 OLD MAGNOLIA TRL
CANTON GA
30115-7979
US

V. Phone/Fax

Practice location:
  • Phone: 925-336-6832
  • Fax:
Mailing address:
  • Phone: 925-336-6832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number158649
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN300140
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: