Healthcare Provider Details

I. General information

NPI: 1891864658
Provider Name (Legal Business Name): INTEGRITY ANESTHESIA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MOUNTAIN DRIVE
DAHLONEGA GA
30533-1614
US

IV. Provider business mailing address

PO BOX 1565
DAHLONEGA GA
30533-0027
US

V. Phone/Fax

Practice location:
  • Phone: 706-867-4116
  • Fax: 706-867-4120
Mailing address:
  • Phone: 706-867-4116
  • Fax: 706-867-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number035327
License Number StateGA

VIII. Authorized Official

Name: MS. KIM DOREEN GABLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-867-4116