Healthcare Provider Details

I. General information

NPI: 1346911542
Provider Name (Legal Business Name): MRC ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PROFESSIONAL PARK DR
CUMMING GA
30040-2381
US

IV. Provider business mailing address

105 PROFESSIONAL PARK DR
CUMMING GA
30040-2381
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-3455
  • Fax: 770-284-8380
Mailing address:
  • Phone: 770-800-3455
  • Fax: 770-284-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ASHLEY N DORSEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-746-6380