Basic Information
| Provider Information | |||||||||
| NPI: | 1053881706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE VALLEY ANESTHESIA ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 945765 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303945765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002425080 | ||||||||
| FaxNumber: | 7279007770 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 N STATE OF FRANKLIN RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234343700 | ||||||||
| FaxNumber: | 4239290662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2018 | ||||||||
| LastUpdateDate: | 04/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KREGER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4045929282 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.