Basic Information
| Provider Information | |||||||||
| NPI: | 1679967400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA ADJUNCT SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850001 | ||||||||
| Address2: | DEPT # 191 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328854380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887280882 | ||||||||
| FaxNumber: | 7572827614 | ||||||||
| Practice Location | |||||||||
| Address1: | 2604 MIDWAY RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300304571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888514642 | ||||||||
| FaxNumber: | 2404651101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | DERANEY | ||||||||
| AuthorizedOfficialFirstName: | JARED | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4804820934 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.