Provider Demographics
NPI:1710602784
Name:COBBLESTONE ANESTHESIA INCORPORATED
Entity Type:Organization
Organization Name:COBBLESTONE ANESTHESIA INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-794-6643
Mailing Address - Street 1:3450 ACWORTH DUE WEST RD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1078
Mailing Address - Country:US
Mailing Address - Phone:770-794-6643
Mailing Address - Fax:770-794-6683
Practice Address - Street 1:3450 ACWORTH DUE WEST RD NW STE 200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1078
Practice Address - Country:US
Practice Address - Phone:770-794-6643
Practice Address - Fax:770-794-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty