Provider Demographics
NPI:1538403324
Name:OKEFENOKEE ANESTHESIA COMPANY LLC
Entity type:Organization
Organization Name:OKEFENOKEE ANESTHESIA COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-285-0877
Mailing Address - Street 1:1501 ALICE STREET
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501
Mailing Address - Country:US
Mailing Address - Phone:800-204-0099
Mailing Address - Fax:336-882-2216
Practice Address - Street 1:1501 ALICE STREET
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:800-204-0099
Practice Address - Fax:336-882-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty