Provider Demographics
NPI:1275354722
Name:L G ANESTHESIA SERVICE, INC
Entity type:Organization
Organization Name:L G ANESTHESIA SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:386-986-6489
Mailing Address - Street 1:6570 TRAILBLAZER RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5313
Mailing Address - Country:US
Mailing Address - Phone:386-986-6489
Mailing Address - Fax:
Practice Address - Street 1:6570 TRAILBLAZER RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5313
Practice Address - Country:US
Practice Address - Phone:386-986-6489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty