Provider Demographics
NPI:1700187184
Name:LAKELANDS NURSE ANESTHESIA SERVICES,LLC
Entity Type:Organization
Organization Name:LAKELANDS NURSE ANESTHESIA SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-650-1056
Mailing Address - Street 1:213 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-9222
Mailing Address - Country:US
Mailing Address - Phone:706-650-1056
Mailing Address - Fax:706-650-1056
Practice Address - Street 1:213 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9222
Practice Address - Country:US
Practice Address - Phone:706-650-1056
Practice Address - Fax:706-650-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210850367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty