Provider Demographics
NPI:1144299629
Name:NORTHSIDE CHEROKEE ANESTHESIA CONSULTANTS, PC
Entity type:Organization
Organization Name:NORTHSIDE CHEROKEE ANESTHESIA CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-720-5100
Mailing Address - Street 1:PO BOX 4790
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-0230
Mailing Address - Country:US
Mailing Address - Phone:770-720-1063
Mailing Address - Fax:770-720-4508
Practice Address - Street 1:201 HOSPITAL RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2408
Practice Address - Country:US
Practice Address - Phone:770-720-5100
Practice Address - Fax:770-720-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBET