Basic Information
| Provider Information | |||||||||
| NPI: | 1073886370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS ANESTHESIA SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 JOHNSON FERRY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047852008 | ||||||||
| FaxNumber: | 4047854496 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 JOHNSON FERRY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047852008 | ||||||||
| FaxNumber: | 4047854496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2012 | ||||||||
| LastUpdateDate: | 02/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | WARREN | ||||||||
| AuthorizedOfficialTitleorPosition: | PEDIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 4047855650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN140297 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.