Healthcare Provider Details

I. General information

NPI: 1164418489
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA OF ATLANTA, P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CANTON ROAD SUITE 100
MARIETTA GA
30060-7259
US

IV. Provider business mailing address

3155 N POINT PKWY ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100
ALPHARETTA GA
30005
US

V. Phone/Fax

Practice location:
  • Phone: 678-574-0943
  • Fax: 678-574-0943
Mailing address:
  • Phone: 770-645-9181
  • Fax: 770-645-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STANFORD R PLAVIN
Title or Position: PRESIDENT
Credential: MD
Phone: 678-574-0943