Healthcare Provider Details

I. General information

NPI: 1972743987
Provider Name (Legal Business Name): PLATINUM ANESTHESIA COASTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N RIVER ST DEPT OF ANESTHESIA
CLAXTON GA
30417-1659
US

IV. Provider business mailing address

PO BOX 68
TENNILLE GA
31089-0068
US

V. Phone/Fax

Practice location:
  • Phone: 912-739-5000
  • Fax:
Mailing address:
  • Phone: 800-605-9961
  • Fax: 800-782-0704

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: KELLY ATKINSON
Title or Position: DIRECTOR
Credential:
Phone: 800-605-9961