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NPI Code Detail

MEDICARE: DAVID I ANTOKAL CRNA

MEDICARE: DAVID I ANTOKAL 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
1367500000XCertified Registered Nurse AnesthetistRN129608GA
2367500000XCertified Registered Nurse AnesthetistAPRN11000385FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417910001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID I ANTOKAL CRNA
Provider Business Mailing Address
First Line : 119 AMBULANCE DR
Second Line : SUITE 202
City : CARROLLTON
State : GA
Zip : 30117-3857
Country : US
Telephone Number : 770-836-9666
Fax Number : 770-836-9212
Provider Business Practice Location Address
First Line : 601 DALLAS HWY
Second Line :
City : VILLA RICA
State : GA
Zip : 30180-1202
Country : US
Telephone Number : 770-456-3000
Fax Number : 770-456-3460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 01/04/2019

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Directions to “ DAVID I ANTOKAL CRNA” Practice Location

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