Healthcare Provider Details

I. General information

NPI: 1164708400
Provider Name (Legal Business Name): AMSOL ANESTHETISTS OF GEORGIA LLC-HUGHSTON SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262B VETERANS PKWY
COLUMBUS GA
31909
US

IV. Provider business mailing address

PO BOX 243
LANDISVILLE PA
17538-0243
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-3434
  • Fax:
Mailing address:
  • Phone: 800-339-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALAN DALE HILLIARD
Title or Position: CFO
Credential:
Phone: 336-884-1830