Healthcare Provider Details

I. General information

NPI: 1801892641
Provider Name (Legal Business Name): FREDERICK JAMES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

118 SAND LAPPER CV
BLUFFTON SC
29910-9316
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-6000
  • Fax:
Mailing address:
  • Phone: 516-241-7736
  • Fax: 516-499-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number257003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: