NPIMap

Organization Active NPI

South Metro Anesthesia Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Locust Grove, GA
National Provider Identifier
1497310759
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SOUTH METRO ANESTHESIA ASSOCIATES, LLC
Practice address
4865 Bill Gardner Pkwy
Locust Grove, GA 30248-3644
Phone
(770) 692-0100
NPI assigned
May 2, 2019
Last updated
Jul 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Authorized official

Name
Jeff Perry
Title
VP of RCM
Phone
(502) 418-4700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

4865 Bill Gardner Pkwy
Locust Grove, GA 30248-3644

Mailing address

3414 Peachtree Rd NE Ste 340
Atlanta, GA 30326-1137
Phone (425) 803-3885

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190703000877 GA Part B Supplier - Clinic/Group Practice 4880928340 Receives reassigned benefits from 18 practitioners
Practice locations: Riverdale, GA; Locust Grove, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1497310759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3414 PEACHTREE RD NE STE 340",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303261137",
            "telephone_number": "425-803-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4865 BILL GARDNER PKWY",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483644",
            "telephone_number": "770-692-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH METRO ANESTHESIA ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-02",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "VP OF RCM",
        "authorized_official_telephone_number": "502-418-4700"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Locust Grove, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.