Basic Information
| Provider Information | |||||||||
| NPI: | 1942717590 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUERSWALD | ||||||||
| FirstName: | COREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2655 NORTHWINDS PKWY | ||||||||
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| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300092280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786908332 | ||||||||
| FaxNumber: | 6789921463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E UNION ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387033246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627252749 | ||||||||
| FaxNumber: | 6627253913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2018 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 9014714 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.