Healthcare Provider Details

I. General information

NPI: 1922402445
Provider Name (Legal Business Name): PERIMETER ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
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: 808-408-0200
  • Fax:
Mailing address:
  • Phone: 888-408-0200
  • Fax: 888-505-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN146149
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY GORDON BARTON
Title or Position: OWNER - MANAGER
Credential: CRNA
Phone: 888-408-0200