Healthcare Provider Details

I. General information

NPI: 1902991987
Provider Name (Legal Business Name): HECTOR MANUEL NEGRON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6649 LAKE DR
MORROW GA
30260-2354
US

IV. Provider business mailing address

PO BOX 278
JONESBORO GA
30237-0278
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-9978
  • Fax: 770-968-9975
Mailing address:
  • Phone: 770-968-9978
  • Fax: 770-968-9975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11041723
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN138297
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: