Provider Demographics
NPI:1780805564
Name:SIRNY, JASON (CRNA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SIRNY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211
Mailing Address - Country:US
Mailing Address - Phone:478-955-5769
Mailing Address - Fax:
Practice Address - Street 1:610 PLUM
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-955-5769
Practice Address - Fax:478-955-5769
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169127367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA440677502AOtherPEACHSTATE CMO - MCCG
GA344393OtherWELLCARE CMO - MCCG
GA440677502AMedicaid
GAP00147040OtherRAILROAD MCR - MCCG
GAP02704Medicare UPIN
GA344393OtherWELLCARE CMO - MCCG