Provider Demographics
NPI:1942972575
Name:ANESTHESIA SERVICES OF GEORGIA LLC
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:404-731-9686
Mailing Address - Street 1:7433 SPOUT SPRINGS RD
Mailing Address - Street 2:SUITE 101-60
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542
Mailing Address - Country:US
Mailing Address - Phone:404-731-9686
Mailing Address - Fax:
Practice Address - Street 1:7433 SPOUT SPRINGS RD
Practice Address - Street 2:SUITE 101-60
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:404-731-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty