Organization
IPS OF CONYERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL RICHARDSON NOBACK M.D. (MEDICAL DIRECTOR)
(888) 337-3309
Entity
Organization
Contact information
Practice address
1301 SIGMAN RD NE, SUITE 120, CONYERS, GA 30012-3812
(770) 760-9360
Mailing address
PO BOX 864778, ORLANDO, FL 32886-0001
(888) 337-3509
(941) 328-3997
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
02/17/2012
Last updated
07/30/2012
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