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General NPI Number Information
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NPI Number | 1407638224
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Entity Type | Organization
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Legal Business Name | SOUTHERN ANESTHESIA OF AUGUSTA LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 110 PEPPER HILL WAY
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City | AIKEN
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State | SC
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Zip | 29801-2818
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Country | US
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Telephone | 706-737-9250
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Fax | 706-733-0697
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Provider Business Mailing Address
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Address Line | PO BOX 16579
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City | AUGUSTA
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State | GA
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Zip | 30919-2579
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Country | US
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Telephone | 706-737-9250
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Fax | 706-733-0697
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Authorized Official
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Title or Position | AGENT
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Name | JASON ANTHONY FAUNCE
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Credential | CRNA
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Telephone | 706-855-9860
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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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