MEDICARE: CORAL ANESTHESIA ASSOCIATES, 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	207L00000X	Anesthesiology Physician

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	:	1255701306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL ANESTHESIA ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	PO BOX 744569
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1879 VETERANS PARK DR
Second Line	:	SUITE 1101
City	:	NAPLES
State	:	FL
Zip	:	34109-0500
Country	:	US
Telephone Number	:	239-248-7623
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER KENNEDY
Credential	:
Telephone Number	:	207-807-9009

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	07/31/2025

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