Healthcare Provider Details

I. General information

NPI: 1558102772
Provider Name (Legal Business Name): PHYSICIANS ANESTHESIA GROUP STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 202
JACKSON MS
39216-4607
US

IV. Provider business mailing address

7956 VAUGHN RD STE 165
MONTGOMERY AL
36116-6819
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-1990
  • Fax:
Mailing address:
  • Phone: 601-277-0060
  • Fax: 866-502-1008

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: RYAN BRUCE WEATHERS
Title or Position: MANAGER
Credential:
Phone: 334-425-1583