1649416660 NPI number — VERALYNN ANESTHESIA ASSOCIATES OF GEORGIA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649416660 NPI number — VERALYNN ANESTHESIA ASSOCIATES OF GEORGIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERALYNN ANESTHESIA ASSOCIATES OF GEORGIA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649416660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
273 STOVALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGRANGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30241-9094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-845-1473
Provider Business Mailing Address Fax Number:
336-553-3994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 FRANKLIN SPRINGS ST
Provider Second Line Business Practice Location Address:
DEPT OF ANESTHESIA
Provider Business Practice Location Address City Name:
ROYSTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30662-3934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-245-5071
Provider Business Practice Location Address Fax Number:
336-553-3994
Provider Enumeration Date:
12/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
706-845-1473

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN065069 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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