Basic Information
| Provider Information | |||||||||
| NPI: | 1326706763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE ANESTHESIA SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 661495 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352661495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | BLAIRSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067452111 | ||||||||
| FaxNumber: | 7064396456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2021 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | ERIN | ||||||||
| AuthorizedOfficialTitleorPosition: | ORGANIZER | ||||||||
| AuthorizedOfficialTelephone: | 8505160788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
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.