Provider Demographics
NPI:1689957250
Name:MOBILE ANESTHESIA OF GEORGIA LLC
Entity Type:Organization
Organization Name:MOBILE ANESTHESIA OF GEORGIA LLC
Other - Org Name:MOBILE ANESTHESIOLOGISTS OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANFORD
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:PLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-552-9236
Mailing Address - Street 1:6111 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:BUILDING E, SUITE 101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6049
Mailing Address - Country:US
Mailing Address - Phone:770-552-9236
Mailing Address - Fax:770-529-0928
Practice Address - Street 1:6111 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:BUILDING E, SUITE 101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6049
Practice Address - Country:US
Practice Address - Phone:770-552-9236
Practice Address - Fax:770-529-0928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULATORY ANESTHESIA OF ATLANTA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039201207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty