Basic Information
| Provider Information | |||||||||
| NPI: | 1073986048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KERSHAW ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1343 CANTON RD STE C | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300666079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662148600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1315 ROBERTS ST | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290203737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033106282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8662148600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.