Provider Demographics
NPI:1518785195
Name:MAE ANESTHESIOLOGY LLC
Entity type:Organization
Organization Name:MAE ANESTHESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEWYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-718-5123
Mailing Address - Street 1:PO BOX 3424
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-3424
Mailing Address - Country:US
Mailing Address - Phone:706-612-0761
Mailing Address - Fax:706-739-4770
Practice Address - Street 1:5669 PEACHTREE DUNWOODY STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1762
Practice Address - Country:US
Practice Address - Phone:605-718-5123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty