David A Agnew, AAC
Individual provider Active NPI Anesthesiologist Assistant · Gainesville, GA
NPI 1487600672 · NPPES record last updated Mar 27, 2012
Key facts
- NPI
- 1487600672
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiologist Assistant 367H00000X
- License
- 002553 (GA)
- Practice address
- 743 Spring St NE
Gainesville, GA 30501-3715 - Phone
- (770) 532-7179
- Fax
- (770) 534-1312
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Associate of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002553 | GA | MD | Mental Health Counselor |
| 2553 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesiology Consultants PC | Past | Accepting new patients | |
| Memorial Health Anesthetists | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiologist Assistant | 367H00000X | 002553 | GA | Yes |
Addresses
Primary practice location
743 Spring St NE
Gainesville, GA 30501-3715
Mailing address
PO Box 1076
Gainesville, GA 30503-1076
Phone (770) 532-7179
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100001211B | Medicaid | GA | |
| 100001211C | Medicaid | GA |
Other providers in Gainesville, GA
- Afton M. Burt, PH.D., P.C.
- Folatomi Agbe-Davies
- Olanrewaju Agbe-Davies
- Deepak K Aggarwal
- Chinelo Aghaji
- Neha Agrawal
- Abigail Aguilera
- Amanda Marie Aguirre-Johnson
- Hadia Rahma Ahmad
- Moaz Ahmad
All providers in Gainesville, GA · Anesthesiologist Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.