MEDICARE: ABC ANESTHESIA ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053975961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC ANESTHESIA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2176 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2030
Country	:	US
Telephone Number	:	404-408-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2176 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2030
Country	:	US
Telephone Number	:	404-408-3100
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	BARBARA GOLDSMITH
Credential	:
Telephone Number	:	404-408-3100

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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Directions to “ABC ANESTHESIA ASSOCIATES LLC ” Practice Location

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