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General NPI Number Information
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NPI Number | 1568158418
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Entity Type | Organization
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Legal Business Name | EVEREST ANESTHESIA LLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1265 HIGHWAY 54 W STE 401
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4537
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Country | US
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Telephone | 843-651-2624
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Fax | 843-357-4940
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Provider Business Mailing Address
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Address Line | PO BOX 117710
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City | ATLANTA
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State | GA
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Zip | 30368-7710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KIRAN KANJI
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Credential | MD
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Telephone | 770-823-0610
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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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Taxonomy #2
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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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