Healthcare Provider Details

I. General information

NPI: 1154413979
Provider Name (Legal Business Name): GEORGE SIVERT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E GRAY ST
LOUISVILLE KY
40202-2026
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2880
  • Fax:
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-434-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1031203
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: