=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538124201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHEAST ANESTHESIOLOGY CONSULTANTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 927 EAST BLVD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-377-5772
-----------------------------------------------------
Fax | 704-377-3389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 WALT WHITMAN RD STE 300
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-208-4250
-----------------------------------------------------
Fax | 704-248-5537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDGAR C GARRABRANT III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 754-247-4124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------