Provider Demographics
NPI:1497870562
Name:AMBULATORY ANESTHESIA OF NORTH GEORGIA, LLC
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIA OF NORTH GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STINESPRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-532-7179
Mailing Address - Street 1:1488 JESSE JEWELL PKWY SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3804
Mailing Address - Country:US
Mailing Address - Phone:770-532-7179
Mailing Address - Fax:770-534-1312
Practice Address - Street 1:1488 JESSE JEWELL PKWY SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3803
Practice Address - Country:US
Practice Address - Phone:770-532-7179
Practice Address - Fax:770-534-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7514Medicare ID - Type Unspecified