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General NPI Number Information
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NPI Number | 1386028744
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Entity Type | Organization
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Legal Business Name | MAK ANESTHESIA, LLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1621 N ROBERTS RD NW STE 110
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City | KENNESAW
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State | GA
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Zip | 30144-3640
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Country | US
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Telephone | 770-702-1806
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 OLD 41 HWY NW STE 112-328
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City | KENNESAW
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State | GA
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Zip | 30152-4480
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Country | US
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Telephone | 770-702-1806
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. PAMELA WEIGANDT
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Credential | M.D.
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Telephone | 770-702-1806
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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 | OCC003663
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License Number State | GA
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