Healthcare Provider Details

I. General information

NPI: 1740448885
Provider Name (Legal Business Name): ANESTHESIA PROVIDERS OF AUGUSTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MIMS RD
SYLVANIA GA
30467-1994
US

IV. Provider business mailing address

PO BOX 12001
AUGUSTA GA
30914-2001
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-0131
  • Fax: 706-854-0131
Mailing address:
  • Phone: 706-868-0131
  • Fax: 706-854-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN112820
License Number StateGA

VIII. Authorized Official

Name: SHANNON M THOMAS
Title or Position: SOUL OWNER
Credential: C.R.N.A.
Phone: 706-836-4915