Healthcare Provider Details

I. General information

NPI: 1417384488
Provider Name (Legal Business Name): NORTH MACON ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BOWMAN RD
MACON GA
31210-8879
US

IV. Provider business mailing address

PO BOX 936156
ATLANTA GA
31193-6156
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-6576
  • Fax:
Mailing address:
  • Phone: 877-244-9741
  • Fax: 877-244-9741

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: DR. JOSHUA A PERKEL
Title or Position: MEMBER/MANAGER
Credential:
Phone: 478-745-6576