Basic Information
| Provider Information | |||||||||
| NPI: | 1114996600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE ANESTHESIA CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 465446 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300425446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702371561 | ||||||||
| FaxNumber: | 7702371124 | ||||||||
| Practice Location | |||||||||
| Address1: | 1170 CLEVELAND AVE | ||||||||
| Address2: | ANESTHESIA/SURGERY DEPT | ||||||||
| City: | EAST POINT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303443615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044661700 | ||||||||
| FaxNumber: | 7702371124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROMAN | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4044661700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.