Organization
ENTI ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY M GALLUPS MD (CEO)
(770) 740-1860
Entity
Organization
Contact information
Practice address
1595 HIGHWAY 34 E, NEWNAN, GA 30265-2353
(678) 206-2202
(678) 673-5155
Mailing address
2365 OLD MILTON PKWY, SUITE 300, ALPHARETTA, GA 30009-2140
(770) 740-1860
(678) 347-2104
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14063148
CERTIFICATE OF ORGANIZATION
GA
Enumeration date
07/02/2014
Last updated
07/02/2014
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