Healthcare Provider Details

I. General information

NPI: 1104962125
Provider Name (Legal Business Name): J&L ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 WILMINGTON ISLAND RD SUITE A
SAVANNAH GA
31410-4502
US

IV. Provider business mailing address

736 WILMINGTON ISLAND RD SUITE A
SAVANNAH GA
31410-4502
US

V. Phone/Fax

Practice location:
  • Phone: 912-844-9900
  • Fax:
Mailing address:
  • Phone: 912-844-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JOHANNA MARIE MALEKI
Title or Position: PRESIDENT OF J&L ANESTHESIA
Credential: CRNA
Phone: 912-844-9900