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General NPI Number Information
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NPI Number | 1417211590
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Entity Type | Organization
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Legal Business Name | ELIOS ANESTHESIOLOGY GROUP, PA
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 1938 WEDDINGTON ROAD SUITE K
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City | WEDDINGTON
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State | NC
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Zip | 28105-8318
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Country | US
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Telephone | 704-708-4545
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Fax | 704-708-4536
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Provider Business Mailing Address
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Address Line | 1938 WEDDINGTON RD STE K
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City | WEDDINGTON
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State | NC
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Zip | 28104-8318
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Country | US
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Telephone | 704-708-4545
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Fax | 704-708-4536
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Authorized Official
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Title or Position | OWNER
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Name | VASILIKI COLLINS
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Credential | MD
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Telephone | 704-708-4545
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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 | 9400450
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License Number State | NC
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