Healthcare Provider Details

I. General information

NPI: 1427709948
Provider Name (Legal Business Name): ANDREA PATRICIA BIRD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FAIR RD
STATESBORO GA
30458-1683
US

IV. Provider business mailing address

39 GROVE CIR
STATESBORO GA
30458-0401
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1150
  • Fax:
Mailing address:
  • Phone: 706-498-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN224011
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN224011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: