NPIMap

Organization Active NPI

Nmda Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Macon, GA
National Provider Identifier
1306123336
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
NMDA ANESTHESIA LLC
Practice address
577 Mulberry St Ste 110
Macon, GA 31201-8220
Phone
(888) 728-0882
NPI assigned
Nov 4, 2011
Last updated
Aug 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Authorized official

Name
Richard Douberly, CRNANPI 1942311428
Title
Member Manager
Phone
(888) 728-0882

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 Anesthetist 367500000X Primary

Addresses

Primary practice location

577 Mulberry St Ste 110
Macon, GA 31201-8220

Mailing address

PO Box 850001 Dept 740U
Orlando, FL 32885-4380
Phone (941) 360-1566

Other practice location 1

4080 McGinnis Ferry Rd Ste 102
Alpharetta, GA 30005-3901
Phone (888) 728-0882 ext. 1

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120105000663 GA Part B Supplier - Clinic/Group Practice 7113193541 Receives reassigned benefits from 84 practitioners
Practice locations: Carrollton, GA; Columbus, GA; Cumming, GA; Hawkinsville, GA; Johns Creek, GA; Valdosta, GA

National Provider Directory

National Provider Directory

Locations

146 Smitherman Rd
Ringgold, GA 30736
Phone (423) 667-3225

95 Bel Air Dr
Statesboro, GA 30461
Phone (912) 489-6519

Practitioners & affiliated clinicians

Practitioners 102

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 102

NPI Registry JSON

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1306123336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850001 DEPT 740U",
            "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": "577 MULBERRY ST STE 110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312018220",
            "telephone_number": "888-728-0882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4080 McGinnis Ferry Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300053901",
            "country_code": "US",
            "telephone_number": "888-728-0882 x1",
            "fax_number": "888-512-1507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NMDA ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-04",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "DOUBERLY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "888-728-0882",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.