Provider Demographics
NPI:1497016059
Name:SOUTHERN ANESTHESIA CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SOUTHERN ANESTHESIA CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGUDELO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:478-787-9153
Mailing Address - Street 1:403 LAKEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6127
Mailing Address - Country:US
Mailing Address - Phone:478-787-9153
Mailing Address - Fax:478-238-6841
Practice Address - Street 1:403 LAKEVIEW PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-6127
Practice Address - Country:US
Practice Address - Phone:478-787-9153
Practice Address - Fax:478-238-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty