Provider Demographics
NPI:1174670103
Name:BDT ANESTHESIA ASSOCIATES PC
Entity Type:Organization
Organization Name:BDT ANESTHESIA ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-278-2473
Mailing Address - Street 1:PO BOX 3330
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3330
Mailing Address - Country:US
Mailing Address - Phone:803-278-2473
Mailing Address - Fax:803-278-2473
Practice Address - Street 1:2260 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4764
Practice Address - Country:US
Practice Address - Phone:706-481-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31336207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty