Provider Demographics
NPI:1598752685
Name:PEMERTON, ANTHONY TRAVIS (CRNA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TRAVIS
Last Name:PEMERTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:110 VALLEY BROOK DR SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5966
Mailing Address - Country:US
Mailing Address - Phone:706-234-5651
Mailing Address - Fax:706-234-5651
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-234-5651
Practice Address - Fax:706-234-5651
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN116161367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered