Provider Demographics
NPI:1780944694
Name:SHAMROCK ANESTHESIA LLC
Entity type:Organization
Organization Name:SHAMROCK ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-4740
Mailing Address - Street 1:2400 BELLEVUE RD STE 22
Mailing Address - Street 2:P. O. BOX 1716
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2889
Mailing Address - Country:US
Mailing Address - Phone:478-275-4740
Mailing Address - Fax:478-275-0533
Practice Address - Street 1:2400 BELLEVUE RD STE 22
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2889
Practice Address - Country:US
Practice Address - Phone:478-275-4740
Practice Address - Fax:478-275-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty