Organization
ASTORIA OF MIDDLE GA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM ENRIQUE AGUDELO CRNA (PRESIDENT)
(478) 787-9153
Entity
Organization
Contact information
Practice address
403 LAKEVIEW PL, MACON, GA 31211-6127
(478) 787-9153
Mailing address
403 LAKEVIEW PL, MACON, GA 31211-6127
(478) 787-9153
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
03/05/2012
Last updated
06/08/2012
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