Provider Demographics
NPI:1326569187
Name:GI ANESTHESIA OF GEORGIA LLC
Entity Type:Organization
Organization Name:GI ANESTHESIA OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GILREATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-888-7575
Mailing Address - Street 1:PO BOX 75449
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5449
Mailing Address - Country:US
Mailing Address - Phone:888-337-3509
Mailing Address - Fax:
Practice Address - Street 1:1955 TEXTILE WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2543
Practice Address - Country:US
Practice Address - Phone:404-888-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty