Healthcare Provider Details

I. General information

NPI: 1386216604
Provider Name (Legal Business Name): ANESTHESIA SERVICES OF NORTH GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S ENOTA DR NE
GAINESVILLE GA
30501-2437
US

IV. Provider business mailing address

PO BOX 660685
BIRMINGHAM AL
35266-0685
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-0292
  • Fax:
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN DAVIDSON
Title or Position: OWNER
Credential: CRNA
Phone: 404-731-9686