Healthcare Provider Details

I. General information

NPI: 1033271481
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 S MAIN ST
MADISON GA
30650-2073
US

IV. Provider business mailing address

PO BOX 72483
MARIETTA GA
30007-2483
US

V. Phone/Fax

Practice location:
  • Phone: 770-578-1800
  • Fax:
Mailing address:
  • Phone: 770-578-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRGIL E BEALL
Title or Position: PRESIDENT
Credential: MD
Phone: 770-578-1800