Healthcare Provider Details

I. General information

NPI: 1598801524
Provider Name (Legal Business Name): JAMES A JOSEPH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 CLEAR CREEK PKWY
LAVONIA GA
30553-4173
US

IV. Provider business mailing address

4523 HIGHWAY 246 N
HODGES SC
29653-9705
US

V. Phone/Fax

Practice location:
  • Phone: 706-356-7800
  • Fax: 706-567-6036
Mailing address:
  • Phone: 864-374-7363
  • Fax: 706-567-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN079744
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: