Provider Demographics
NPI:1134751191
Name:PEACH STATE ANESTHESIA PARTNERS, LLC
Entity type:Organization
Organization Name:PEACH STATE ANESTHESIA PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRUBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-746-7577
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-0570
Mailing Address - Country:US
Mailing Address - Phone:888-276-1910
Mailing Address - Fax:770-701-6718
Practice Address - Street 1:350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:478-746-7577
Practice Address - Fax:478-765-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty