Healthcare Provider Details

I. General information

NPI: 1689938144
Provider Name (Legal Business Name): ASTORIA ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HICKORY STREET
WARNER ROBINS GA
31093-3047
US

IV. Provider business mailing address

102 HICKORY STREET
WARNER ROBINS GA
31093-3047
US

V. Phone/Fax

Practice location:
  • Phone: 800-204-0099
  • Fax: 336-882-2216
Mailing address:
  • Phone: 800-204-0099
  • Fax: 336-882-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM E AGUDELO
Title or Position: CRNA/OWNER
Credential: CRNA
Phone: 478-787-9153