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Organization

DREAM TEAM ANESTHESIA ASSOCIATES INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNICE H GIST CRNA (CEO/PRESIDENT)
(478) 929-0036
Entity
Organization

Contact information

Practice address
807 CARROLL ST STE C-2002, PERRY, GA 31069-3311
(855) 491-8869
(478) 352-0095
Mailing address
PO BOX 629, PERRY, GA 31069-0629
(855) 491-8869
(478) 352-0095

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
664068606B
GA
01
Q05682
UPIN
GA
01
RN134488
STATE LICENSE
GA
Enumeration date
04/12/2018
Last updated
04/13/2018
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