Organization
FIRST SOURCE ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD DOUBERLY CRNA (MEMBER MANAGER)
(888) 728-0882
Entity
Organization
Contact information
Practice address
577 MULBERRY ST STE 110, MACON, GA 31201-8220
(888) 728-0882
Mailing address
PO BOX 850001, DEPT #249, ORLANDA, FL 32885-0249
(888) 728-0882
(888) 512-1507
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
GA
Other
Enumeration date
01/15/2016
Last updated
08/14/2020
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