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NPI Code Detail

MEDICARE: SPECTRUM ANESTHESIA, LLC

MEDICARE: SPECTRUM ANESTHESIA, LLC
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 AnesthetistRN219398GA

General Provider Information

NPI Number : 1578074993
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTRUM ANESTHESIA, LLC
Provider Business Mailing Address
First Line : 1639 BRADLEY PARK DR STE 500
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-3623
Country : US
Telephone Number : 573-579-9048
Fax Number :
Provider Business Practice Location Address
First Line : 67 PEACHTREE PARK DR NE STE 101
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1318
Country : US
Telephone Number : 573-579-9048
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. MICHAEL MERCER
Credential :
Telephone Number : 573-579-9048
Provider Enumeration Date : 10/12/2017
Last Update Date : 10/12/2017

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Directions to “SPECTRUM ANESTHESIA, LLC ” Practice Location

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