Provider Demographics
NPI:1104679935
Name:ADVANCED ANESTHESIA CARE
Entity type:Organization
Organization Name:ADVANCED ANESTHESIA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-459-4954
Mailing Address - Street 1:PO BOX 956141
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9503
Mailing Address - Country:US
Mailing Address - Phone:678-459-4954
Mailing Address - Fax:678-606-7631
Practice Address - Street 1:1462 MONTREAL RD STE 109
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6904
Practice Address - Country:US
Practice Address - Phone:678-459-4954
Practice Address - Fax:678-606-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty