Healthcare Provider Details

I. General information

NPI: 1306854104
Provider Name (Legal Business Name): SMYRNA ANESTHESIA, LLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 S COBB DR SE
SMYRNA GA
30080-6342
US

IV. Provider business mailing address

3949 S COBB DR SE
SMYRNA GA
30080-6342
US

V. Phone/Fax

Practice location:
  • Phone: 770-438-5229
  • Fax: 770-438-4356
Mailing address:
  • Phone: 770-438-5229
  • Fax: 770-438-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS KILEY
Title or Position: PRESIDENT
Credential:
Phone: 770-438-5229