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General NPI Number Information
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NPI Number | 1184294761
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Entity Type | Organization
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Legal Business Name | GSG ANESTHESIA, LLC
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 721 WELLNESS WAY STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3304
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Country | US
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Telephone | 770-339-8452
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Fax | 770-277-2930
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Provider Business Mailing Address
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Address Line | 721 WELLNESS WAY STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3304
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Country | US
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Telephone | 770-339-8452
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Fax | 770-277-2930
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM GORDON TANNER JR.
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Credential | MD
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Telephone | 770-339-8452
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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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