NPIMap

Organization Active NPI

Classic City Anesthesia Associates

  • Certified Registered Nurse Anesthetist
  • Athens, GA
National Provider Identifier
1619150745
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
CLASSIC CITY ANESTHESIA ASSOCIATES
Practice address
1720 Epps Bridge Pkwy
Suite 108-382
Athens, GA 30606-6132
Phone
(706) 540-7780
NPI assigned
Dec 12, 2007
Last updated
Dec 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Authorized official

Name
Mr. Wallace S. Phillips, CRNANPI 1528166717
Title
Paractice Manager
Phone
(706) 549-2700

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

1720 Epps Bridge Pkwy
Suite 108-382
Athens, GA 30606-6132

Mailing address

1720 Epps Bridge Pkwy
Suite 108-382
Athens, GA 30606-6132
Phone (706) 540-7780

Other identifiers 1

IdentifierTypeStateIssuer
432CBR612MedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197417600000",
    "number": "1619150745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 EPPS BRIDGE PKWY",
            "address_2": "SUITE 108-382",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066132",
            "telephone_number": "706-540-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 EPPS BRIDGE PKWY",
            "address_2": "SUITE 108-382",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066132",
            "telephone_number": "706-540-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLASSIC CITY ANESTHESIA ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2007-12-12",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PARACTICE MANAGER",
        "authorized_official_telephone_number": "706-549-2700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432CBR612",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2007; 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.