Provider Demographics
NPI:1891864658
Name:INTEGRITY ANESTHESIA P.C.
Entity Type:Organization
Organization Name:INTEGRITY ANESTHESIA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:DOREEN
Authorized Official - Last Name:GABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-867-4116
Mailing Address - Street 1:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0027
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:30533-1614
Practice Address - Country:US
Practice Address - Phone:706-867-4116
Practice Address - Fax:706-867-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2414Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER