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NPI Code Detail

MEDICARE: FAYETTE COMMUNITY ANESTHESIA

MEDICARE: FAYETTE COMMUNITY ANESTHESIA
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
1207L00000XAnesthesiology PhysicianGA

General Provider Information

NPI Number : 1144220245
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAYETTE COMMUNITY ANESTHESIA
Provider Business Mailing Address
First Line : PO BOX 7836
Second Line :
City : MARIETTA
State : GA
Zip : 30065-1836
Country : US
Telephone Number : 678-202-2060
Fax Number :
Provider Business Practice Location Address
First Line : 1984 PEACHTREE RD NW
Second Line : SUITE 515
City : ATLANTA
State : GA
Zip : 30309-1298
Country : US
Telephone Number : 404-351-1745
Fax Number :
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : MR. MIKE KOLESAR
Credential :
Telephone Number : 404-351-1745
Provider Enumeration Date : 07/29/2005
Last Update Date : 08/22/2020

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1922093152 — STEPHEN C GOLDEN
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1588623110 — PEACHTREE LABORATORY ASSOCIATES PC
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Directions to “FAYETTE COMMUNITY ANESTHESIA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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