Basic Information
| Provider Information | |||||||||
| NPI: | 1013268655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHENS ANESTHESIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 629 | ||||||||
| Address2: | |||||||||
| City: | PERRY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310690629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664580036 | ||||||||
| FaxNumber: | 4789291744 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 CARROLL ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | PERRY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310693311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664580036 | ||||||||
| FaxNumber: | 4789291744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2012 | ||||||||
| LastUpdateDate: | 09/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | WEIR | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7064252239 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARE PLUS MEDICAL PRACTICE LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.