Healthcare Provider Details

I. General information

NPI: 1679967400
Provider Name (Legal Business Name): ANESTHESIA ADJUNCT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HIGHWAY 54 W STE 401
FAYETTEVILLE GA
30214-4537
US

IV. Provider business mailing address

PO BOX 850001 DEPT # 191
ORLANDO FL
32885-4380
US

V. Phone/Fax

Practice location:
  • Phone: 888-851-4642
  • Fax: 240-465-1101
Mailing address:
  • Phone: 888-728-0882
  • Fax: 757-282-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LAURA G ADKINS
Title or Position: EXECUTIVE VP OF OPERATIONS
Credential:
Phone: 828-424-0869