Provider Demographics
NPI:1265482582
Name:ANESTHESIA AND PAIN MEDICINE
Entity Type:Organization
Organization Name:ANESTHESIA AND PAIN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-737-9250
Mailing Address - Street 1:1824 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3804
Mailing Address - Country:US
Mailing Address - Phone:706-737-9250
Mailing Address - Fax:706-733-0697
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-737-9250
Practice Address - Fax:706-733-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4788Medicare ID - Type UnspecifiedMEDICARE NUMBER