Healthcare Provider Details

I. General information

NPI: 1144362864
Provider Name (Legal Business Name): FAYETTEVILLE ANESTHESIA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 METROMEDICAL DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

135 DUNDEE RD.
FAYETTEVILLE NC
28303
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-6440
  • Fax: 910-609-5365
Mailing address:
  • Phone: 910-480-0727
  • Fax: 910-323-4142

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. EVERETT L. PERRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 910-480-0727