Healthcare Provider Details

I. General information

NPI: 1760989925
Provider Name (Legal Business Name): DREAM TEAM ANESTHESIA ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CARROLL ST STE C-2002
PERRY GA
31069-3311
US

IV. Provider business mailing address

PO BOX 629
PERRY GA
31069-0629
US

V. Phone/Fax

Practice location:
  • Phone: 855-491-8869
  • Fax: 478-352-0095
Mailing address:
  • Phone: 855-491-8869
  • Fax: 478-352-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JENNICE H GIST
Title or Position: CEO/PRESIDENT
Credential: CRNA
Phone: 478-929-0036