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General NPI Number Information
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NPI Number | 1639303126
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Entity Type | Organization
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Legal Business Name | ASTORIA ANESTHESIA ASSOCIATES LLC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 403 LAKEVIEW PL
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City | MACON
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State | GA
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Zip | 31211-6127
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Country | US
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Telephone | 478-787-9153
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Fax | 478-238-6841
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Provider Business Mailing Address
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Address Line | 403 LAKEVIEW PL
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City | MACON
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State | GA
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Zip | 31211-6127
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Country | US
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Telephone | 478-787-9153
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Fax | 478-238-6841
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Authorized Official
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Title or Position | MEMBER
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Name | WILLIAM E AGUDELO
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Credential | CRNA
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Telephone | 478-787-9153
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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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