Organization
BLUE WATER ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE GAYNES (REGISTERED AGENT)
(404) 467-7526
Entity
Organization
Contact information
Practice address
2175 NORTH RD, SNELLVILLE, GA 30078-2630
(770) 979-0900
(770) 979-2852
Mailing address
PO BOX 700, SNELLVILLE, GA 30078-0700
(770) 979-0900
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN191954
GA
Other
Enumeration date
10/22/2014
Last updated
01/26/2015
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