MEDICARE: GT 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
1	367500000X	Certified Registered Nurse Anesthetist	APN3094	SC

General Provider Information

NPI Number	:	1487918504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GT ANESTHESIA

Provider Business Mailing Address
First Line	:	1728 W CANNING DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9311
Country	:	US
Telephone Number	:	843-906-3276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 W CANNING DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9311
Country	:	US
Telephone Number	:	843-906-3276
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	MRS. TAMMY LAWLER IVY
Credential	:	CRNA
Telephone Number	:	843-906-3276

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	07/03/2012

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