Provider Demographics
NPI:1134149420
Name:HABERSHAM ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:HABERSHAM ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-839-6205
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:TURNERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30580-0369
Mailing Address - Country:US
Mailing Address - Phone:706-839-6205
Mailing Address - Fax:706-754-9668
Practice Address - Street 1:541 HISTORIC HWY 441 N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-839-6205
Practice Address - Fax:706-754-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055003127AMedicaid
GAGRP2993Medicare ID - Type UnspecifiedMEDICARE GROUP ID