Healthcare Provider Details

I. General information

NPI: 1750494316
Provider Name (Legal Business Name): METRO WEST ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8954 HOSPITAL DR
DOUGLASVILLE GA
30134-2272
US

IV. Provider business mailing address

8954 HOSPITAL DR
DOUGLASVILLE GA
30134-2272
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: H DAVID SANUSI
Title or Position: PRESIDENT
Credential: MD
Phone: 706-660-8505