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General NPI Number Information
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NPI Number | 1316236367
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Entity Type | Organization
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Legal Business Name | GENESIS ANESTHESIA SERVICES, PLLC
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 1059 NEAL ST SUITE B
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City | COOKEVILLE
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State | TN
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Zip | 38501-0946
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Country | US
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Telephone | 615-620-2320
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Fax | 615-620-2323
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Provider Business Mailing Address
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Address Line | PO BOX 291264
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City | NASHVILLE
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State | TN
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Zip | 37229-1264
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Country | US
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Telephone | 615-620-2320
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Fax | 615-620-2323
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT A HAMILTON
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Credential | CRNA
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Telephone | 615-620-2320
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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 |
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License Number State |
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