Basic Information
Provider Information
NPI: 1356525125
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAUSS
FirstName: ADAM
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 598 3RD ST
Address2:  
City: MACON
State: GA
PostalCode: 312013357
CountryCode: US
TelephoneNumber: 4786336706
FaxNumber: 4786335384
Practice Location
Address1: 777 HEMLOCK ST
Address2:  
City: MACON
State: GA
PostalCode: 312012102
CountryCode: US
TelephoneNumber: 4786331000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/28/2007
LastUpdateDate: 02/29/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN161740GAN Nursing Service ProvidersRegistered Nurse 
367500000XRN161740GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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