Provider Demographics
NPI:1215225560
Name:PROGRESSIVE ANESTHESIA LLC
Entity type:Organization
Organization Name:PROGRESSIVE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:770-719-3240
Mailing Address - Street 1:PO BOX 117714
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7714
Mailing Address - Country:US
Mailing Address - Phone:770-719-3240
Mailing Address - Fax:240-342-3837
Practice Address - Street 1:1265 HIGHWAY 54 W STE 401
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4537
Practice Address - Country:US
Practice Address - Phone:770-719-3240
Practice Address - Fax:240-342-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty