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General NPI Number Information
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NPI Number | 1245895614
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Entity Type | Organization
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Legal Business Name | GSD ANESTHESIA PROVIDERS, LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 3292 MOUNTAIN DR
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City | DECATUR
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State | GA
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Zip | 30032-1102
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Country | US
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Telephone | 404-294-8180
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Fax | 404-294-8188
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Provider Business Mailing Address
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Address Line | 3292 MOUNTAIN DR
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City | DECATUR
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State | GA
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Zip | 30032-1102
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Country | US
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Telephone | 404-294-8180
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Fax | 404-294-8188
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Authorized Official
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Title or Position | MANAGER
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Name | LESLIE A HARRIS
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Credential | MBA
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Telephone | 623-363-1333
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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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