Charlie Adderley
Individual provider Active NPI Certified Registered Nurse Anesthetist · Jackson, MS
NPI 1588023378 · NPPES record last updated Jan 20, 2023
Key facts
- NPI
- 1588023378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- RN126097 (GA)
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-1000
- NPI assigned
- Feb 22, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Emory Specialty Associates, LLC
Gi Anesthesia of Georgia LLC
Practice addresses (Care Compare)
1821 Clifton Rd NE
Atlanta, GA 30329-4021
Phone (404) 728-6812
1955 Textile Way
Gainesville, GA 30501-2543
Phone (404) 888-7575
Hospital & facility affiliations
- Emory University Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.51 of 100
- Quality
- 80.61
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161207000482 | GA | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 2567769573 | Reassigns benefits to 11 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN126097 | GA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emory Specialty Associates, LLC | Current |
Accepting new patients | |
| Coastal Ambulatory Anesthesia LLC | Current |
Accepting new patients | |
| New London Anesthesia & Pain Consultants PC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Sentry Anesthesia Management, LLC | Current |
Accepting new patients | |
| Grady Memorial Hospital Corporation | Current |
Accepting new patients | |
| Grady Memorial Hospital Corporation | Current |
Accepting new patients | |
| Physician Specialists in Anesthesia, P.C. | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Premier Anesthesia of Georgia LLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Anesthesia Dynamics LLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
Locations (25 of 29)
7956 Vaughn Rd
Ste 165
Montgomery, AL 36116
126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011
340 N Milledge Ave
Ste A
Athens, GA 30601
Phone (706) 548-0008
550 Peachtree St NE
Ste 1660
Atlanta, GA 30308
Phone (404) 253-6820
550 Peachtree St NE
Ste 1600
Atlanta, GA 30308
Phone (404) 881-1094
1821 Clifton Rd NE
Atlanta, GA 30329
Phone (404) 728-6812
2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193
80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370
1515 River Pl
Ste 320
Braselton, GA 30517
Phone (678) 997-2125
2675 N Decatur Rd
Ste 506
Decatur, GA 30033
Phone (404) 299-1679
8855 Hospital Dr
Ste 102
Douglasville, GA 30134
Phone (678) 784-5020
1255 Highway 54 W
Fayetteville, GA 30214
Phone (770) 719-6911
1955 Textile Way
Gainesville, GA 30501
Phone (678) 987-1499
226 E College St
#A
Griffin, GA 30224
Phone (678) 987-1490
6335 Hospital Pkwy
Ste 208
Johns Creek, GA 30097
Phone (404) 645-7150
488 Kennesaw Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 427-3075
1200 Lower Fayetteville Rd
#A
Newnan, GA 30265
Phone (404) 881-1094
34 Upper Riverdale Rd SE
Ste 201
Riverdale, GA 30274
Phone (678) 904-0094
6555 Professional Pl
Ste B
Riverdale, GA 30274
Phone (770) 692-0100
11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277
5671 Ptree Dunwoody Rd NE
Ste 680
Sandy Springs, GA 30342
Phone (404) 705-6985
5665 Ptree Dunwoody Rd NE
Sandy Springs, GA 30342
Phone (678) 843-7001
5671 Ptree Dunwoody Rd NE
Ste 800
Sandy Springs, GA 30342
Phone (404) 257-1415
1139 Lexington Ave
Savannah, GA 31404
Phone (912) 303-4200
1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN126097 | GA | Yes |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08977750 | Medicaid | MS | |
| P01679805 | Other | MS | RAILROAD MEDICARE |
Other providers in Jackson, MS
- Adria Nicole Adcock
- Dorothy Adcock
- Kim Griffin Adcock
- Taylor Adcock
- Amy R Adcox
- Holland M Addison
- Clement Addo
- Kehinde Adewale Adebisi
- Charles Ayo Adedara
- Barrie E Aden
All providers in Jackson, MS · Certified Registered Nurse Anesthetist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.