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General NPI Number Information
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NPI Number | 1700187184
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Entity Type | Organization
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Legal Business Name | LAKELANDS NURSE ANESTHESIA SERVICES,LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 213 EVERGREEN DR
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City | GREENWOOD
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State | SC
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Zip | 29649-9222
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Country | US
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Telephone | 706-650-1056
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Fax | 706-650-1056
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Provider Business Mailing Address
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Address Line | 213 EVERGREEN DR
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City | GREENWOOD
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State | SC
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Zip | 29649-9222
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Country | US
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Telephone | 706-650-1056
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Fax | 706-650-1056
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARTIN KNIGHT
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Credential |
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Telephone | 706-650-1056
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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 | RN210850
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License Number State | GA
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