Healthcare Provider Details

I. General information

NPI: 1295811073
Provider Name (Legal Business Name): GILES COUNTY ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E COLLEGE ST
PULASKI TN
38478-4541
US

IV. Provider business mailing address

PO BOX 440401
NASHVILLE TN
37244-0401
US

V. Phone/Fax

Practice location:
  • Phone: 931-363-7531
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ENRIQUE MOLINA
Title or Position: PARTNER
Credential: CRNA
Phone: 615-620-2320