Organization
CSRA ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEAN ROGER LOSS CRNA (PRESIDENT)
(706) 868-1410
Entity
Organization
Contact information
Practice address
4480 SPARKLEBERRY CT, EVANS, GA 30809-4454
(706) 868-0131
(706) 210-0771
Mailing address
P O BOX 21151, MARTINEZ, GA 30917-1551
(706) 868-0131
(706) 854-0131
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1388
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
RN108812
GA
Other
Enumeration date
05/19/2010
Last updated
04/13/2011
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