Healthcare Provider Details

I. General information

NPI: 1255482550
Provider Name (Legal Business Name): MONROE ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N BROAD ST
WINDER GA
30680-2150
US

IV. Provider business mailing address

PO BOX 724928
ATLANTA GA
31139-9028
US

V. Phone/Fax

Practice location:
  • Phone: 770-929-5858
  • Fax:
Mailing address:
  • Phone: 770-929-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. MORRISON JACQUITTE
Title or Position: OWNER
Credential: MD.
Phone: 770-929-5858