Basic Information
| Provider Information | |||||||||
| NPI: | 1649416660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERALYNN ANESTHESIA ASSOCIATES OF GEORGIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 273 STOVALL RD | ||||||||
| Address2: | |||||||||
| City: | LAGRANGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302419094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068451473 | ||||||||
| FaxNumber: | 3365533994 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 FRANKLIN SPRINGS ST | ||||||||
| Address2: | DEPT OF ANESTHESIA | ||||||||
| City: | ROYSTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306623934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062455071 | ||||||||
| FaxNumber: | 3365533994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2008 | ||||||||
| LastUpdateDate: | 12/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7068451473 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN065069 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.