Provider Demographics
NPI:1386737393
Name:AMBULATORY ANESTHESIA ALLIANCE OF GA LLC
Entity type:Organization
Organization Name:AMBULATORY ANESTHESIA ALLIANCE OF GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDOLFO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-396-6190
Mailing Address - Street 1:1870 INDEPENDENCE SQ STE D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5155
Mailing Address - Country:US
Mailing Address - Phone:770-396-6190
Mailing Address - Fax:770-396-5541
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:770-396-6190
Practice Address - Fax:770-396-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BDJTTMedicare ID - Type UnspecifiedANA MARIA ROXO MD
GA05BDJTRMedicare ID - Type UnspecifiedROBERT J. BURTON JR. MD
GA05BDJTSMedicare ID - Type UnspecifiedARMANDO ALAM-GONZALEZ MD