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General NPI Number Information
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NPI Number | 1104679935
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Entity Type | Organization
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Legal Business Name | ADVANCED ANESTHESIA CARE
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1462 MONTREAL RD STE 109
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City | TUCKER
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State | GA
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Zip | 30084-6904
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Country | US
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Telephone | 678-459-4954
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Fax | 678-606-7631
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Provider Business Mailing Address
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Address Line | PO BOX 956141
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City | DULUTH
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State | GA
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Zip | 30095-9503
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Country | US
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Telephone | 678-459-4954
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Fax | 678-606-7631
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TANESHA UPCHURCH
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Credential |
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Telephone | 678-459-4954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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