Provider Demographics
NPI:1659675718
Name:SUPERIOR ANESTHESIA FOR EVERYONE OF GEORGIA, P.C.
Entity Type:Organization
Organization Name:SUPERIOR ANESTHESIA FOR EVERYONE OF GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:WOOLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:CRNA
Authorized Official - Phone:850-251-2511
Mailing Address - Street 1:1320 MADISON AVE S
Mailing Address - Street 2:#145
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4417
Mailing Address - Country:US
Mailing Address - Phone:850-251-2511
Mailing Address - Fax:
Practice Address - Street 1:302 S WAYNE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2922
Practice Address - Country:US
Practice Address - Phone:850-251-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty