Provider Demographics
NPI:1346781085
Name:DMD ANESTHESIA LLC
Entity Type:Organization
Organization Name:DMD ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:IDOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-537-1131
Mailing Address - Street 1:1611 RYMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3891
Mailing Address - Country:US
Mailing Address - Phone:706-537-1131
Mailing Address - Fax:
Practice Address - Street 1:1436 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2637
Practice Address - Country:US
Practice Address - Phone:706-537-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50891207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty