Organization
AMNESTIC, LLC
Active
Organization
AMNESTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HANI DAVID SANUSI M.D. (PRESIDENT)
(706) 660-8505
Entity
Organization
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(706) 660-8505
(706) 660-9390
Mailing address
2500 DALLAS HWY SW STE 202, BOX 160, MARIETTA, GA 30064-7505
(706) 660-8505
(706) 660-9390
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036450
GA
207LP2900X
Pain Medicine (Anesthesiology) Physician
036450
GA
Other
Enumeration date
05/16/2012
Last updated
10/12/2012
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