MEDICARE: ORACLE ANESTHESIA OF GEORGIA 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
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1629350566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORACLE ANESTHESIA OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 370160
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30037-0160
Country	:	US
Telephone Number	:	404-403-4567
Fax Number	:	404-920-8185

Provider Business Practice Location Address
First Line	:	76 HIGHLAND PAVILION CT STE 133
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3170
Country	:	US
Telephone Number	:	800-533-8210
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DANA BRADLEY
Credential	:
Telephone Number	:	404-593-4392

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	06/12/2023

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