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General NPI Number Information
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NPI Number | 1700287232
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Entity Type | Organization
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Legal Business Name | SIESTA ANESTHESIA SERVICES, LLC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 100 HARTSFIELD CENTER PKWY SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30354-1341
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Country | US
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Telephone | 404-376-3639
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HARTSFIELD CENTER PKWY SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30354-1341
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Country | US
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Telephone | 404-376-3639
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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 | MR. TAJ K. EUBANKS
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Credential | M.D.
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Telephone | 404-376-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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