Healthcare Provider Details

I. General information

NPI: 1700187184
Provider Name (Legal Business Name): LAKELANDS NURSE ANESTHESIA SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 EVERGREEN DR
GREENWOOD SC
29649-9222
US

IV. Provider business mailing address

213 EVERGREEN DR
GREENWOOD SC
29649-9222
US

V. Phone/Fax

Practice location:
  • Phone: 706-650-1056
  • Fax: 706-650-1056
Mailing address:
  • Phone: 706-650-1056
  • Fax: 706-650-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN210850
License Number StateGA

VIII. Authorized Official

Name: MR. MARTIN KNIGHT
Title or Position: OWNER
Credential:
Phone: 706-650-1056