Organization
BLUE RIDGE ANESTHESIA ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA NICHOLSON (OFFICE MANAGER)
(706) 258-4040
Entity
Organization
Contact information
Practice address
11 OVERVIEW DR, BLUE RIDGE, GA 30513-6611
(706) 258-4040
(706) 258-4041
Mailing address
PO BOX 69, BLUE RIDGE, GA 30513-0002
(706) 258-4040
(706) 258-4041
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10039401
AMERIGROUP
GA
05
—
300029069A
—
GA
05
—
8000177
—
NC
Enumeration date
12/05/2006
Last updated
07/25/2011
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