Provider Demographics
NPI:1639462971
Name:PINNACLE ANESTHESIA OF WOODSTOCK, PC
Entity Type:Organization
Organization Name:PINNACLE ANESTHESIA OF WOODSTOCK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-720-1063
Mailing Address - Street 1:125 GAY THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4745
Mailing Address - Country:US
Mailing Address - Phone:770-720-1063
Mailing Address - Fax:770-720-4508
Practice Address - Street 1:1505 STONE BRIDGE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8251
Practice Address - Country:US
Practice Address - Phone:770-926-9112
Practice Address - Fax:770-720-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty