Organization
GEORGIA ANESTHESIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH JOHNSON (PRESIDENT)
(336) 553-1659
Entity
Organization
Contact information
Practice address
2003 ALICE ST, SUITE 2003B, WAYCROSS, GA 31501-6209
(912) 490-3338
(336) 553-3994
Mailing address
PO BOX 18666, GREENSBORO, NC 27419-8666
(336) 553-3999
(336) 553-3994
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
04/13/2016
Last updated
04/21/2016
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