Provider Demographics
NPI:1609202720
Name:MAK ANESTHESIA NW LLC
Entity Type:Organization
Organization Name:MAK ANESTHESIA NW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ABERCROMBIE
Authorized Official - Last Name:WEIGANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-702-1806
Mailing Address - Street 1:1635 OLD 41 HIGHWAY NW, SUITE 112-328
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152
Mailing Address - Country:US
Mailing Address - Phone:770-702-1806
Mailing Address - Fax:770-693-0810
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:SUITE 218
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8665
Practice Address - Country:US
Practice Address - Phone:770-738-7887
Practice Address - Fax:770-732-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty