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General NPI Number Information
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NPI Number | 1801446455
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Entity Type | Organization
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Legal Business Name | MEDNAX
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 770 PINE ST STE L40
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City | MACON
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State | GA
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Zip | 31201-7521
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Country | US
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Telephone | 478-633-9670
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Fax |
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Provider Business Mailing Address
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Address Line | 107 BILLY PYLE RD SW
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City | ROME
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State | GA
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Zip | 30165-3520
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ANESTHESIOLOGIST ASSISTANT
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Name | ALIE EASTERWOOD
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Credential | CAA
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Telephone | 706-346-9605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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