Organization
CLASSIC CITY ANESTHESIA ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALLACE S. PHILLIPS CRNA (PARACTICE MANAGER)
(706) 549-2700
Entity
Organization
Contact information
Practice address
1720 EPPS BRIDGE PKWY, SUITE 108-382, ATHENS, GA 30606-6132
(706) 540-7780
Mailing address
1720 EPPS BRIDGE PKWY, SUITE 108-382, ATHENS, GA 30606-6132
(706) 540-7780
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432CBR612
—
GA
Enumeration date
12/12/2007
Last updated
12/12/2007
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