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General NPI Number Information
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NPI Number | 1730497074
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Entity Type | Organization
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Legal Business Name | NASC ANESTHESIA
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 2365 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2140
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Country | US
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Telephone | 770-753-0053
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Fax | 770-753-0021
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Provider Business Mailing Address
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Address Line | 2365 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2140
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Country | US
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Telephone | 770-753-0053
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Fax | 770-753-0021
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY M. GALLUPS
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Credential | MD
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Telephone | 770-740-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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