Provider Demographics
NPI:1164418489
Name:AMBULATORY ANESTHESIA OF ATLANTA, P C
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIA OF ATLANTA, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-574-0943
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:780 CANTON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7259
Practice Address - Country:US
Practice Address - Phone:678-574-0943
Practice Address - Fax:678-574-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3876Medicare PIN