1942713326 NPI number — SOUTHCARE ANESTHESIA SERVICES, 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 1942713326 NPI number — SOUTHCARE ANESTHESIA SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHCARE ANESTHESIA SERVICES, 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:
6
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:
1942713326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 673
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30168-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-941-4810
Provider Business Mailing Address Fax Number:
770-948-9149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 MEDICAL PARK DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30106-6831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-941-4810
Provider Business Practice Location Address Fax Number:
770-948-9149
Provider Enumeration Date:
11/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFERS
Authorized Official First Name:
JASMINE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
770-941-4810

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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