Organization
WWS INNOVATIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL R NOBACK MD (MEDICAL DIRECTOR)
(888) 337-3509
Entity
Organization
Contact information
Practice address
2001 PROFESSIONAL WAY, SUITE 270, WOODSTOCK, GA 30188-6442
(770) 926-0771
(770) 926-9321
Mailing address
PO BOX 864825, ORLANDO, FL 32886-0001
(888) 337-3509
(941) 328-3997
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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