Provider Demographics
NPI:1528004538
Name:DEKALB ANESTHESIA ASSOCIATES, P A
Entity Type:Organization
Organization Name:DEKALB ANESTHESIA ASSOCIATES, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODING/BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDONATO
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:678-514-2643
Mailing Address - Street 1:2171 W PARK CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3555
Mailing Address - Country:US
Mailing Address - Phone:678-514-1991
Mailing Address - Fax:678-514-1993
Practice Address - Street 1:2701 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5918
Practice Address - Country:US
Practice Address - Phone:404-501-5265
Practice Address - Fax:404-501-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GAGRP1527Medicare PIN