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General NPI Number Information
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NPI Number | 1528015930
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Entity Type | Organization
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Legal Business Name | GWINNETT ANESTHESIA SERVICE PC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7694
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Country | US
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Telephone | 770-963-9905
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-0669
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Country | US
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Telephone | 770-963-9905
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. DANIEL M CHAPMAN
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Credential |
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Telephone | 770-963-9905
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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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