Healthcare Provider Details

I. General information

NPI: 1942717590
Provider Name (Legal Business Name): COREY AUERSWALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E UNION ST
GREENVILLE MS
38703-3246
US

IV. Provider business mailing address

2655 NORTHWINDS PKWY
ALPHARETTA GA
30009-2280
US

V. Phone/Fax

Practice location:
  • Phone: 662-725-2749
  • Fax: 662-725-3913
Mailing address:
  • Phone: 678-690-8332
  • Fax: 678-992-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9014714
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: