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General NPI Number Information
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NPI Number | 1336761840
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHARM ANESTHESIA ASSOCIATES
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 1148 GREAT GLEN WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9103
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Country | US
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Telephone | 678-471-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 GREAT GLEN WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9103
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Country | US
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Telephone | 678-471-5362
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAKASIA PATRICE HILL
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Credential | CRNA
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Telephone | 678-471-5362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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