1831483205 NPI number — GP ANESTHESIOLOGY

Table of content: (NPI 1831483205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831483205 NPI number — GP ANESTHESIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GP ANESTHESIOLOGY
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:
1831483205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30677-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-337-3509
Provider Business Mailing Address Fax Number:
941-328-3997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3292 MOUNTAIN DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30032-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-623-4271
Provider Business Practice Location Address Fax Number:
706-225-7217
Provider Enumeration Date:
06/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WEIR
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
706-425-2239

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN114614 , 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)

  • Identifier: 114614 . This is a "CYB" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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