Organization
PLATINUM ANESTHESIA COASTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ATKINSON (DIRECTOR)
(800) 605-9961
Entity
Organization
Contact information
Practice address
200 N RIVER ST, DEPT OF ANESTHESIA, CLAXTON, GA 30417-1659
(912) 739-5000
Mailing address
PO BOX 68, TENNILLE, GA 31089-0068
(800) 605-9961
(800) 782-0704
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
568167122A
—
GA
01
—
DO7086
MEDICARE RAILROAD
GA
Enumeration date
03/03/2009
Last updated
09/13/2011
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