MEDICARE: MR. PETER PAUL CHVALA JR. 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	RN095429	GA

General Provider Information

NPI Number	:	1417024688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER PAUL CHVALA JR. CRNA

Provider Business Mailing Address
First Line	:	2328 MILSTEAD CIR NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5769
Country	:	US
Telephone Number	:	770-578-4640
Fax Number	:	770-977-7327

Provider Business Practice Location Address
First Line	:	2328 MILSTEAD CIR NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5769
Country	:	US
Telephone Number	:	770-578-4640
Fax Number	:	770-977-7327

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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