Organization
SOUTHEAST GEORGIA ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH R JOHNSON MD (MEMBER)
(336) 553-1659
Entity
Organization
Contact information
Practice address
410 DARLING AVE, ANESTHESIA DEPT, WAYCROSS, GA 31501-5246
(336) 553-1659
(336) 553-3994
Mailing address
PO BOX 18824, GREENSBORO, NC 27419-8824
(336) 553-1659
(336) 553-3994
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
999314012A
—
GA
Enumeration date
10/27/2006
Last updated
11/30/2010
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