Healthcare Provider Details

I. General information

NPI: 1629350566
Provider Name (Legal Business Name): ORACLE ANESTHESIA OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 HIGHLAND PAVILION CT STE 133
HIRAM GA
30141-3170
US

IV. Provider business mailing address

PO BOX 370160
DECATUR GA
30037-0160
US

V. Phone/Fax

Practice location:
  • Phone: 800-533-8210
  • Fax:
Mailing address:
  • Phone: 404-403-4567
  • Fax: 404-920-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANA BRADLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-593-4392