Provider Demographics
NPI:1407638224
Name:SOUTHERN ANESTHESIA OF AUGUSTA LLC
Entity Type:Organization
Organization Name:SOUTHERN ANESTHESIA OF AUGUSTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FAUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-855-9860
Mailing Address - Street 1:PO BOX 16579
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-2579
Mailing Address - Country:US
Mailing Address - Phone:706-737-9250
Mailing Address - Fax:706-733-0697
Practice Address - Street 1:110 PEPPER HILL WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2818
Practice Address - Country:US
Practice Address - Phone:706-737-9250
Practice Address - Fax:706-733-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty