Healthcare Provider Details

I. General information

NPI: 1528153632
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF DALTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

PO BOX 2563
DALTON GA
30722-2563
US

V. Phone/Fax

Practice location:
  • Phone: 706-271-0100
  • Fax: 706-270-0487
Mailing address:
  • Phone: 706-271-0100
  • Fax: 706-270-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL MORRISON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 423-310-1642