Provider Demographics
NPI:1336109552
Name:ASIS, ANA C (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:C
Last Name:ASIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 MILL GROVE TER
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5013
Mailing Address - Country:US
Mailing Address - Phone:770-614-5376
Mailing Address - Fax:770-614-5376
Practice Address - Street 1:3343 MILL GROVE TER
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5013
Practice Address - Country:US
Practice Address - Phone:770-614-5376
Practice Address - Fax:770-614-5376
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72195207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41943ZMedicare ID - Type Unspecified
FLG89442Medicare UPIN