Basic Information
| Provider Information | |||||||||
| NPI: | 1497870562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY ANESTHESIA OF NORTH GEORGIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1488 JESSE JEWELL PKWY SE STE 100 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705327179 | ||||||||
| FaxNumber: | 7705341312 | ||||||||
| Practice Location | |||||||||
| Address1: | 1488 JESSE JEWELL PKWY SE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705327179 | ||||||||
| FaxNumber: | 7705341312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | STINESPRING | ||||||||
| AuthorizedOfficialFirstName: | TEENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7705327179 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.