Healthcare Provider Details

I. General information

NPI: 1790299592
Provider Name (Legal Business Name): GBAA HOLDINGS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45A DISCOVERY WAY
ACTON MA
01720-4482
US

IV. Provider business mailing address

PO BOX 739572
DALLAS TX
75373-9572
US

V. Phone/Fax

Practice location:
  • Phone: 978-429-2000
  • Fax:
Mailing address:
  • Phone: 888-717-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFF PERRY
Title or Position: VP OF RCM
Credential:
Phone: 502-418-4700