Organization
MONROE ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MORRISON JACQUITTE MD. (OWNER)
(770) 929-5858
Entity
Organization
Contact information
Practice address
316 N BROAD ST, WINDER, GA 30680-2150
(770) 929-5858
Mailing address
PO BOX 724928, ATLANTA, GA 31139-9028
(770) 929-5858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP7961
MEDICARE GROUP NUMBER
GA
Enumeration date
01/15/2007
Last updated
12/28/2009
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