Provider Demographics
NPI:1295731917
Name:STROCK, ANN J (CRNA)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:J
Last Name:STROCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3559
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0993
Mailing Address - Country:US
Mailing Address - Phone:770-979-9996
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:770-979-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84532367500000X
GARN154095367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274911Medicaid
NC8051846Medicaid
MI104691875Medicaid
LA1562432Medicaid
AZ794273Medicaid
SCGAN375Medicaid
MS00126662Medicaid
OK100851390AMedicaid
AR136523701Medicaid
OH2460555Medicaid
MO913914115Medicaid
TN3496653Medicaid
ME422400000Medicaid
VA8949531Medicaid
KS200381360AMedicaid
MT4303416Medicaid
TX172580601Medicaid
IN200457710AMedicaid
MI104691875Medicaid