Healthcare Provider Details

I. General information

NPI: 1629427059
Provider Name (Legal Business Name): EPIX ANESTHESIA OF ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HOLCOMB BRIDGE RD BUILDING 100 STE 330
ROSWELL GA
30076-6211
US

IV. Provider business mailing address

3949 HOLCOMB BRIDGE RD STE 300
PEACHTREE CORNERS GA
30092-2208
US

V. Phone/Fax

Practice location:
  • Phone: 678-580-1349
  • Fax: 770-559-1231
Mailing address:
  • Phone: 678-580-1349
  • Fax: 770-559-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIM ADAMS
Title or Position: PRESIDENT
Credential: MD
Phone: 678-580-1349