Provider Demographics
NPI:1669441861
Name:DEGLER, ANITA TRENT (CRNA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:TRENT
Last Name:DEGLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:DIANE
Other - Last Name:DEGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:DEPT 1029
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1549
Mailing Address - Country:US
Mailing Address - Phone:404-778-8311
Mailing Address - Fax:770-495-1581
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:DEPT 1029
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:404-778-8311
Practice Address - Fax:770-495-1581
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN037348367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000550327Medicaid
GA000550327Medicaid