Healthcare Provider Details

I. General information

NPI: 1194785543
Provider Name (Legal Business Name): LOUIS SEMRAD JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 FOUR LAKES DR
MADISON GA
30650-4266
US

IV. Provider business mailing address

1706 FOUR LAKES DR
MADISON GA
30650-4266
US

V. Phone/Fax

Practice location:
  • Phone: 706-342-3763
  • Fax: 706-342-1986
Mailing address:
  • Phone: 706-342-3763
  • Fax: 706-342-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN148996
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN148996
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: