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NPI Code Detail

MEDICARE: ADVANCED ANESTHESIA ASSOCIATES, PC

MEDICARE: ADVANCED ANESTHESIA ASSOCIATES, PC
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
1208VP0000XPain Medicine Physician208VP0000XGA
2367500000XCertified Registered Nurse Anesthetist367500000XGA
3367H00000XAnesthesiologist Assistant367H00000XGA
4207L00000XAnesthesiology Physician207L00000XGA

General Provider Information

NPI Number : 1649260738
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED ANESTHESIA ASSOCIATES, PC
Provider Business Mailing Address
First Line : 405 ARROWHEAD BLVD
Second Line : SUITE C
City : JONESBORO
State : GA
Zip : 30236-1254
Country : US
Telephone Number : 770-478-9877
Fax Number : 770-478-2908
Provider Business Practice Location Address
First Line : 5126 HOSPITAL DR NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2566
Country : US
Telephone Number : 770-478-9877
Fax Number : 770-478-2908
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : MR. DANIEL H. WORLEY
Credential :
Telephone Number : 770-478-9877
Provider Enumeration Date : 10/28/2005
Last Update Date : 12/10/2021

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