Provider Demographics
NPI:1700836970
Name:GUTHAS, KIM LEIGH (CRNA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:LEIGH
Last Name:GUTHAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LEIGH
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:227 MOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533
Mailing Address - Country:US
Mailing Address - Phone:706-867-4116
Mailing Address - Fax:706-867-4120
Practice Address - Street 1:227 MOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533
Practice Address - Country:US
Practice Address - Phone:706-867-4116
Practice Address - Fax:706-867-4120
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113343367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP31993Medicare UPIN
GA43BBBRVMedicare ID - Type Unspecified