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General NPI Number Information
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NPI Number | 1639763386
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Entity Type | Organization
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Legal Business Name | SOUTHERN COMFORT ANESTHESIA
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 2347 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-3232
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Country | US
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Telephone | 770-979-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2733 SKYLAND DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-3759
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Country | US
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Telephone | 470-570-7305
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA N STANDRIDGE
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Credential | CRNA
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Telephone | 678-389-1960
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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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