1790185387 NPI number — GLYNN ANESTHESIA ASSOCIATES, INC.

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 1790185387 NPI number — GLYNN ANESTHESIA ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLYNN ANESTHESIA ASSOCIATES, INC.
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:
1790185387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 235019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36123-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-279-1450
Provider Business Mailing Address Fax Number:
334-395-4110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3217 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-267-0058
Provider Business Practice Location Address Fax Number:
334-395-4110
Provider Enumeration Date:
09/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP, HR
Authorized Official Telephone Number:
334-279-1450

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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