Healthcare Provider Details

I. General information

NPI: 1275585879
Provider Name (Legal Business Name): SOUTHERN CRESCENT ANESTHESIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 VERNON RD
LAGRANGE GA
30240-4131
US

IV. Provider business mailing address

3025 HIGHWAY 154 BLDG B
NEWNAN GA
30265-6121
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-1411
  • Fax:
Mailing address:
  • Phone: 770-251-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE E SPIER
Title or Position: PRESIDENT
Credential: MD
Phone: 770-251-2060