NPIMap

Organization Active NPI

Synergy Anesthesiology Inc

  • Certified Registered Nurse Anesthetist
  • Alpharetta, GA
National Provider Identifier
1003040502
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SYNERGY ANESTHESIOLOGY INC
Practice address
4080 McGinnis Ferry Rd
Ste 102
Alpharetta, GA 30005-3948
Phone
(941) 360-1566
NPI assigned
May 12, 2009
Last updated
Jun 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Richard DouberlyNPI 1942311428
Title
Authorized Official
Phone
(941) 360-1566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

4080 McGinnis Ferry Rd
Ste 102
Alpharetta, GA 30005-3948

Mailing address

PO Box 850001 PO Box 850001
Orlando, FL 32885-4380
Phone (941) 360-1566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091030000317 GA Part B Supplier - Clinic/Group Practice 4385781954 Receives reassigned benefits from 91 practitioners
Practice locations: Macon, GA; Marietta, GA; Martinez, GA; Savannah, GA; Statesboro, GA; Stockbridge, GA; Augusta, GA; Valdosta, GA…
O20170822000109 SC Part B Supplier - Clinic/Group Practice 4385781954 Receives reassigned benefits from 5 practitioners
Practice locations: Anderson, SC

National Provider Directory

National Provider Directory

Locations

1950 SW 18th Ct
Ocala, FL 34471
Phone (352) 789-6575

511 Hewitt St
Pensacola, FL 32503
Phone (850) 912-6505

1776 Peachtree St NW
Ste 2905
Atlanta, GA 30309

1938 Peachtree Rd NW
#L5
Atlanta, GA 30309
Phone (678) 831-2772

3885 Princeton Lakes Way SW
Ste 154
Atlanta, GA 30331

1303 Dantignac St
Ste 2500
Augusta, GA 30901
Phone (706) 722-6900

462 Furys Ferry Rd
Ste 154
Augusta, GA 30907
Phone (706) 868-0599

227 Riverstone Dr
Canton, GA 30114
Phone (770) 720-7733

227 Riverstone Dr
#280
Canton, GA 30114
Phone (770) 720-7733

7130 Mount Zion Blvd
Ste 10
Jonesboro, GA 30236
Phone (770) 473-6811

5400 Bowman Rd
Ste 200
Macon, GA 31210
Phone (478) 621-4501

1040 Morningside Dr
Perry, GA 31069
Phone (478) 988-4676

100 Gavotte Ln
Anderson, SC 29621
Phone (864) 261-7474

Practitioners & affiliated clinicians

Practitioners 118

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 118

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654473600000",
    "number": "1003040502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850001 PO BOX 850001",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328854380",
            "telephone_number": "941-360-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 MCGINNIS FERRY RD",
            "address_2": "STE 102",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300053948",
            "telephone_number": "941-360-1566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY ANESTHESIOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-12",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A",
        "authorized_official_last_name": "DOUBERLY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "941-360-1566",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.