Healthcare Provider Details

I. General information

NPI: 1114996600
Provider Name (Legal Business Name): PROGRESSIVE ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 CLEVELAND AVE ANESTHESIA/SURGERY DEPT
EAST POINT GA
30344-3615
US

IV. Provider business mailing address

PO BOX 465446
LAWRENCEVILLE GA
30042-5446
US

V. Phone/Fax

Practice location:
  • Phone: 404-466-1700
  • Fax: 770-237-1124
Mailing address:
  • Phone: 770-237-1561
  • Fax: 770-237-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARLOS ROMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 404-466-1700