Healthcare Provider Details

I. General information

NPI: 1528015930
Provider Name (Legal Business Name): GWINNETT ANESTHESIA SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30045-7694
US

IV. Provider business mailing address

PO BOX 669
LAWRENCEVILLE GA
30046-0669
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-9905
  • Fax:
Mailing address:
  • Phone: 770-963-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL M CHAPMAN
Title or Position: GENERAL MANAGER
Credential:
Phone: 770-963-9905