Provider Demographics
NPI:1356706709
Name:SOUTHERN ANESTHESIA OF AUGUSTA LLC
Entity type:Organization
Organization Name:SOUTHERN ANESTHESIA OF AUGUSTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-533-4612
Mailing Address - Street 1:PO BOX 16579
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-2579
Mailing Address - Country:US
Mailing Address - Phone:706-868-0131
Mailing Address - Fax:706-854-0131
Practice Address - Street 1:905 STEVENS CREEK RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3201
Practice Address - Country:US
Practice Address - Phone:706-922-6000
Practice Address - Fax:706-722-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty