Provider Demographics
NPI:1003838673
Name:REDMOND ANESTHESIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:REDMOND ANESTHESIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WURL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-254-1969
Mailing Address - Street 1:501 REDMOND ROAD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165
Mailing Address - Country:US
Mailing Address - Phone:706-291-0291
Mailing Address - Fax:706-802-3063
Practice Address - Street 1:501 REDMOND ROAD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-291-0291
Practice Address - Fax:706-802-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20-23868809Medicaid
GAGRP7107OtherMEDICARE GROUP #
GA20-23868809OtherBCBS GA
GAGRP7107OtherMEDICARE GROUP #
GAGRP7107OtherMEDICARE GROUP #