Provider Demographics
NPI:1255397162
Name:INTEGRAL ANESTHESIA SERVICES
Entity type:Organization
Organization Name:INTEGRAL ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEWELL
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-850-1887
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-0490
Mailing Address - Country:US
Mailing Address - Phone:770-914-6777
Mailing Address - Fax:770-614-6070
Practice Address - Street 1:2751 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5244
Practice Address - Country:US
Practice Address - Phone:770-850-1887
Practice Address - Fax:770-996-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA7464OtherRAILROAD MEDICARE GROUP #
GADA7464OtherRAILROAD MEDICARE GROUP #