NPIMap

Organization Active NPI

Georgia Anesthesia Medical Group, LLC

  • Anesthesiology Physician
  • Waycross, GA
National Provider Identifier
1265896484
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
GEORGIA ANESTHESIA MEDICAL GROUP, LLC
Practice address
2003 Alice St
Suite 2003B
Waycross, GA 31501-6209
Phone
(912) 490-3338
Fax
(336) 553-3994
NPI assigned
Apr 13, 2016
Last updated
Apr 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Keith JohnsonNPI 1851308639
Title
President
Phone
(336) 553-1659

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary
Certified Registered Nurse Anesthetist 367500000X NU

Addresses

Primary practice location

2003 Alice St
Suite 2003B
Waycross, GA 31501-6209

Mailing address

PO Box 18666
Greensboro, NC 27419-8666
Phone (336) 553-3999

National Provider Directory

National Provider Directory

Locations

2003 Alice St
Ste 2003B
Waycross, GA 31501
Phone (912) 490-3338

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1265896484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18666",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274198666",
            "telephone_number": "336-553-3999",
            "fax_number": "336-553-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 ALICE ST",
            "address_2": "SUITE 2003B",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016209",
            "telephone_number": "912-490-3338",
            "fax_number": "336-553-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA ANESTHESIA MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-553-1659"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.