Organization
AHP OF PALM COAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG WACHOWIAK (MANAGER)
(770) 945-5330
Entity
Organization
Contact information
Practice address
623 MAITLAND AVE, STE 1100, ALTAMONTE SPRINGS, FL 32701-6823
(407) 830-8661
Mailing address
3079 PEACHTREE INDUSTRIAL BLVD, DULUTH, GA 30097-2215
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
04/22/2008
Last updated
04/22/2008
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