Provider Demographics
NPI:1942713326
Name:SOUTHCARE ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHCARE ANESTHESIA SERVICES, LLC
Other - Org Name:SOUTHCARE ANESTHESIA SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-941-4810
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1007
Mailing Address - Country:US
Mailing Address - Phone:770-941-4810
Mailing Address - Fax:770-948-9149
Practice Address - Street 1:3825 MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6831
Practice Address - Country:US
Practice Address - Phone:770-941-4810
Practice Address - Fax:770-948-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty