Organization
PHOENIX ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANNINE DERANEY (ADMINISTRATOR)
(678) 592-6633
Entity
Organization
Contact information
Practice address
304 MEAD RD, DECATUR, GA 30030-3625
(678) 592-6633
Mailing address
304 MEAD RD, DECATUR, GA 30030-3625
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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