MEDICARE: DWIGHT A KINGRY CRNA

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	RN166317	GA
2	367500000X	Certified Registered Nurse Anesthetist	APN0000010813	TN

General Provider Information

NPI Number	:	1386649937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWIGHT A KINGRY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 551420
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33355-1420
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:	954-839-2569

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD. NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-351-1745
Fax Number	:	404-351-7121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2005
Last Update Date	:	07/31/2023

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