Healthcare Provider Details

I. General information

NPI: 1265424998
Provider Name (Legal Business Name): JAMIE MICHAEL ATKINS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N 7TH ST
CORDELE GA
31015-3234
US

IV. Provider business mailing address

902 N 7TH ST
CORDELE GA
31015-3234
US

V. Phone/Fax

Practice location:
  • Phone: 912-294-6237
  • Fax:
Mailing address:
  • Phone: 912-294-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN086300 APO4390
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN232083
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: