Provider Demographics
NPI:1629007539
Name:CALHOUN ANESTHESIA P C
Entity Type:Organization
Organization Name:CALHOUN ANESTHESIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-602-9995
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-0128
Mailing Address - Country:US
Mailing Address - Phone:706-602-9995
Mailing Address - Fax:706-624-0271
Practice Address - Street 1:1035 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-6008
Practice Address - Country:US
Practice Address - Phone:706-602-9995
Practice Address - Fax:706-624-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA06546OtherBLUE CROSS GP
GAGRP 332OtherMEDICARE GRP NUMBER
GA1C CM5659OtherRAILROAD MEDICARE
GA055001250AMedicaid
GAGRP 332OtherMEDICARE GRP NUMBER