Basic Information
| Provider Information | |||||||||
| NPI: | 1407173891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DREAM WORK ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3023 | ||||||||
| Address2: | |||||||||
| City: | EVANS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308090077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068559860 | ||||||||
| FaxNumber: | 7068607124 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 13TH ST STE 17 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067244111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | HUDSON | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7068559860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.