Provider Demographics
NPI:1518912666
Name:STEPHENS COUNTY ANESTHESIA SERVICES,LLC
Entity Type:Organization
Organization Name:STEPHENS COUNTY ANESTHESIA SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDMUNDS
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-297-7749
Mailing Address - Street 1:452 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2781
Mailing Address - Country:US
Mailing Address - Phone:706-297-7749
Mailing Address - Fax:706-297-7749
Practice Address - Street 1:163 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6820
Practice Address - Country:US
Practice Address - Phone:706-282-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024670282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicare UPIN