Healthcare Provider Details

I. General information

NPI: 1831510361
Provider Name (Legal Business Name): EXCELLENT ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PRIME PT STE H
PEACHTREE CITY GA
30269-3334
US

IV. Provider business mailing address

211 PRIME PT STE H
PEACHTREE CITY GA
30269-3334
US

V. Phone/Fax

Practice location:
  • Phone: 941-360-1566
  • Fax: 941-358-9818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SYED A. HAIDER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 770-542-7636