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General NPI Number Information
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NPI Number | 1063480457
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Entity Type | Individual
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Provider Name | BRENT H. SUDDETH CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 HOSPITAL RD ANESTHESIA DEPT
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City | CANTON
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State | GA
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Zip | 30114-2408
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Country | US
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Telephone | 404-851-6500
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Fax | 770-237-1124
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Provider Business Mailing Address
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Address Line | PO BOX 465686
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City | LAWRENCEVILLE
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State | GA
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Zip | 30042-5686
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Country | US
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Telephone | 770-237-1561
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Fax | 770-237-1124
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN149420
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License Number State | GA
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