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General NPI Number Information
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NPI Number | 1952869828
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Entity Type | Organization
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Legal Business Name | ECLAT ANESTHESIA
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 05/25/2019
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Provider Practice Location Address
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Address Line | 577 MULBERRY ST STE 110
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City | MACON
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State | GA
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Zip | 31201-8220
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Country | US
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Telephone | 240-469-2179
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 850001 DEPT 740A
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City | ORLANDO
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State | FL
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Zip | 32885-0740
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Country | US
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Telephone | 240-469-2179
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KIRBY KITCHENS
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Credential |
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Telephone | 229-886-5347
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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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