Provider Demographics
NPI:1144344920
Name:SOUTHERN ANESTHESIA SERVICE
Entity type:Organization
Organization Name:SOUTHERN ANESTHESIA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-682-6279
Mailing Address - Street 1:1159 OAKTON TRL
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5224
Mailing Address - Country:US
Mailing Address - Phone:706-854-9997
Mailing Address - Fax:706-854-8454
Practice Address - Street 1:1159 OAKTON TRL
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5224
Practice Address - Country:US
Practice Address - Phone:706-854-9997
Practice Address - Fax:706-854-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX IDENTIFICATION
GA=========OtherTAX IDENTIFICATION