Provider Demographics
NPI:1417024688
Name:CHVALA, PETER PAUL JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:PAUL
Last Name:CHVALA
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2328 MILSTEAD CIR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5769
Mailing Address - Country:US
Mailing Address - Phone:770-578-4640
Mailing Address - Fax:770-977-7327
Practice Address - Street 1:2328 MILSTEAD CIR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5769
Practice Address - Country:US
Practice Address - Phone:770-578-4640
Practice Address - Fax:770-977-7327
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095429367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43ZCBMWMedicare ID - Type Unspecified