Provider Demographics
NPI:1689437758
Name:MAK ANESTHESIA PAIN SERVICES, LLC
Entity Type:Organization
Organization Name:MAK ANESTHESIA PAIN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-702-1806
Mailing Address - Street 1:1300 RIDENOUR BLVD NW STE 300
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4402
Mailing Address - Country:US
Mailing Address - Phone:770-702-1806
Mailing Address - Fax:
Practice Address - Street 1:1360 UPPER HEMBREE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1230
Practice Address - Country:US
Practice Address - Phone:770-702-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAK ANESTHESIA HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty