Provider Demographics
NPI:1700035110
Name:JOHNS CREEK ANESTHESIA, LLC
Entity Type:Organization
Organization Name:JOHNS CREEK ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HUDES
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:678-638-6042
Mailing Address - Street 1:4275 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9117
Mailing Address - Country:US
Mailing Address - Phone:678-638-6042
Mailing Address - Fax:
Practice Address - Street 1:4275 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9117
Practice Address - Country:US
Practice Address - Phone:678-638-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty