Provider Demographics
NPI:1487644480
Name:BARTLETT, DANNY A (CRNA)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:A
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4636
Mailing Address - Country:US
Mailing Address - Phone:706-548-2279
Mailing Address - Fax:706-353-3777
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:SUITE100
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-353-3600
Practice Address - Fax:706-353-3777
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN108441367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000546939HMedicaid
GA511I430187Medicare PIN