Provider Demographics
NPI:1205656618
Name:INTEGRATED ANESTHESIA SOLUTIONS, LLC
Entity type:Organization
Organization Name:INTEGRATED ANESTHESIA SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:478-974-1265
Mailing Address - Street 1:577 MULBERRY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8220
Mailing Address - Country:US
Mailing Address - Phone:478-974-1265
Mailing Address - Fax:888-512-1507
Practice Address - Street 1:577 MULBERRY ST STE 110
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8220
Practice Address - Country:US
Practice Address - Phone:478-974-1265
Practice Address - Fax:888-512-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty