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General NPI Number Information
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NPI Number | 1518785195
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Entity Type | Organization
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Legal Business Name | MAE ANESTHESIOLOGY LLC
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 5669 PEACHTREE DUNWOODY STE 210
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City | ATLANTA
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State | GA
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Zip | 30342-1762
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Country | US
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Telephone | 605-718-5123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3424
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City | EATONTON
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State | GA
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Zip | 31024-3424
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Country | US
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Telephone | 706-612-0761
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Fax | 706-739-4770
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Authorized Official
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Title or Position | ADMIN
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Name | CAROL BORDEWYK
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Credential |
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Telephone | 605-718-5123
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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 |
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License Number State |
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Taxonomy #2
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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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