Organization
LIGHTHOUSE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY WALLACE (AUTHORIZED REPRESENTATIVE)
(912) 354-5357
Entity
Organization
Contact information
Practice address
6605 ABERCORN ST, ST. 108, SAVANNAH, GA 31405-5815
(912) 354-5357
Mailing address
804 SCOTT NIXON MEMORIAL DR, AUGUSTA, GA 30907-2464
(800) 394-4445
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
07/25/2007
Last updated
01/08/2008
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