Radiance Anesthesia
Organization Active NPI Certified Registered Nurse Anesthetist · Macon, GA
NPI 1194381236 · NPPES record last updated Dec 2, 2021
Key facts
- NPI
- 1194381236
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- Legal business name
- RADIANCE ANESTHESIA
- Practice address
- 577 Mulberry St Ste 110
Macon, GA 31201-8220 - Phone
- (240) 469-2179
- NPI assigned
- May 14, 2019
- Organization subpart
- No
Authorized official
- Name
- Richard E Douberly Jr.
- Title
- Director
- Phone
- (941) 360-1566
Practitioners 64
-
Ashley W Crocker, CRNA
-
Kevin Michael Duff, CRNA
-
Daniel Eldridge McAlvin, CRNA
-
Korie L Agudelo, CRNA
-
William Enrique Agudelo, CRNA
-
Richard Bloodworth, CRNA
-
Rebecca Ryan Bunt, CRNA
-
Derek Burns, CRNA
-
Kyle Winters Calhoun, CRNA
-
Randall J Cannady, CRNA
-
Ann Marie Chalker, CRNA
-
Jeffrey Elliott Cryder, CRNA
-
Charles Darren Daniel, CRNA
-
Justin Michael Davidson, CRNA
-
Mac Bradley Davis, CRNA
-
Joni Heather Duff, CRNA
-
Terry Joe Durham, C.R.N.A.
-
Walter T Edalgo, CRNA
-
Pamela Ellerbee, CRNA
-
Ryan C Ford, CRNA
-
Joshua Ray Gibbs, CRNA
-
William Lloyd Gillis, CRNA
-
David Howard Gorney, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200526003208 | GA | Part B Supplier - Clinic/Group Practice | 5890116032 |
Receives reassigned benefits from 63 practitioners Practice locations: Albany, GA; Valdosta, GA; Statesboro, GA; Marietta, GA; Macon, GA; Jonesboro, GA; Athens, GA; Fayetteville, GA… |
National Provider Directory
Locations
1620 Prince Ave
Athens, GA 30606
Phone (706) 546-0170
15 Medical Dr NE
Ste 101
Cartersville, GA 30121
Phone (770) 386-5221
2400 Bellevue Rd
Ste 17
Dublin, GA 31021
Phone (478) 274-8600
1523 Fair Rd
Statesboro, GA 30458
Phone (912) 871-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | Yes |
Addresses
Primary practice location
577 Mulberry St Ste 110
Macon, GA 31201-8220
Mailing address
PO Box 850001 Dept 740J
Orlando, FL 32885-0740
Phone (240) 469-2179
Other providers in Macon, GA
- Justin Michael Quion
- Alvina Qureshi
- R. Jason Kent Physical Therapy
- Mijin Ra
- Ashley Danielle Radford
- Radiology Associates of Macon PC
- Radiology Center of Macon LLC
- Alyse Mary Elaine Ragauskas
- Daniela Morgan Ragins
- Jillian Cindy Ragoonath
All providers in Macon, GA · Certified Registered Nurse Anesthetist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.