| NPI | 1275968638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE M NICHOLS Provider Enrollment Specialist 706-650-0705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN616965) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NO11347600) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2013-09-04 |