Provider Demographics
NPI:1104962125
Name:J&L ANESTHESIA INC
Entity type:Organization
Organization Name:J&L ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF J&L ANESTHESIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALEKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:912-844-9900
Mailing Address - Street 1:736 WILMINGTON ISLAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-4502
Mailing Address - Country:US
Mailing Address - Phone:912-844-9900
Mailing Address - Fax:
Practice Address - Street 1:736 WILMINGTON ISLAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-4502
Practice Address - Country:US
Practice Address - Phone:912-844-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000558577CMedicaid
GA000556355GMedicaid
SCGPA659Medicaid
GAGRP3012Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER