Provider Demographics
NPI:1821350471
Name:EARLEY DAZE ANESTHESIA LLC
Entity Type:Organization
Organization Name:EARLEY DAZE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EARLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-899-9080
Mailing Address - Street 1:5751 UPTAIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4077
Mailing Address - Country:US
Mailing Address - Phone:423-899-9080
Mailing Address - Fax:423-424-3690
Practice Address - Street 1:1111 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2588
Practice Address - Country:US
Practice Address - Phone:706-226-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty