Provider Demographics
NPI:1376625863
Name:DEKALB ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DEKALB ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:256-635-0991
Mailing Address - Street 1:P.O. BOX 680045
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968
Mailing Address - Country:US
Mailing Address - Phone:256-635-0991
Mailing Address - Fax:256-635-0992
Practice Address - Street 1:200 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968
Practice Address - Country:US
Practice Address - Phone:256-635-0991
Practice Address - Fax:256-635-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty