Basic Information
| Provider Information | |||||||||
| NPI: | 1477080497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH ATLANTIC ANESTHESIA SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PROVIDENCE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286409244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368467101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2017 | ||||||||
| LastUpdateDate: | 05/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | BENONIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7047495800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2006-00727 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.