Healthcare Provider Details

I. General information

NPI: 1306296801
Provider Name (Legal Business Name): AIMEE M CREER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

IV. Provider business mailing address

PO BOX 896134
CHARLOTTE NC
28289-6134
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-1450
  • Fax: 334-395-4110
Mailing address:
  • Phone: 334-279-1450
  • Fax: 334-395-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN216935
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: