Provider Demographics
NPI:1346569142
Name:CSRA ANESTHESIA
Entity Type:Organization
Organization Name:CSRA ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LOSS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-868-1410
Mailing Address - Street 1:P O BOX 21151
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30917-1551
Mailing Address - Country:US
Mailing Address - Phone:706-868-0131
Mailing Address - Fax:706-854-0131
Practice Address - Street 1:4480 SPARKLEBERRY CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4454
Practice Address - Country:US
Practice Address - Phone:706-868-0131
Practice Address - Fax:706-210-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN108812367500000X
SC1388367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty