Organization
MIDSTATE ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CALTON BRUCE HUCKABY MD (OWNER)
(478) 464-2600
Entity
Organization
Contact information
Practice address
610 3RD ST, STE 206, MACON, GA 31201-3262
(478) 464-2600
Mailing address
610 3RD ST, STE 206, MACON, GA 31201-3262
(478) 464-2600
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/06/2011
Last updated
03/26/2012
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