Healthcare Provider Details

I. General information

NPI: 1255786521
Provider Name (Legal Business Name): GUARDIAN MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 FORSYTH ST
MACON GA
31201-1408
US

IV. Provider business mailing address

PO BOX 18666
GREENSBORO NC
27419-8666
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-4206
  • Fax: 336-553-3994
Mailing address:
  • Phone: 336-553-1659
  • Fax: 336-553-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID BEALL
Title or Position: PRESIDENT
Credential:
Phone: 336-553-3999