MEDICARE: J&L ANESTHESIA INC

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	367500000X	Certified Registered Nurse Anesthetist		GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104962125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J&L ANESTHESIA INC

Provider Business Mailing Address
First Line	:	736 WILMINGTON ISLAND RD
Second Line	:	SUITE A
City	:	SAVANNAH
State	:	GA
Zip	:	31410-4502
Country	:	US
Telephone Number	:	912-844-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 WILMINGTON ISLAND RD
Second Line	:	SUITE A
City	:	SAVANNAH
State	:	GA
Zip	:	31410-4502
Country	:	US
Telephone Number	:	912-844-9900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OF J&L ANESTHESIA
Name	:	MRS. JOHANNA MARIE MALEKI
Credential	:	CRNA
Telephone Number	:	912-844-9900

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/10/2008

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