NPIMap

Organization Active NPI

Excalibur Anesthesia Associates Inc

  • Anesthesiology Physician
  • Conyers, GA
National Provider Identifier
1679933774
Registry record updated Mar 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
EXCALIBUR ANESTHESIA ASSOCIATES INC
Practice address
1301 Sigman Rd NE
Suite 120
Conyers, GA 30012-3812
Phone
(770) 760-9360
NPI assigned
Mar 2, 2016
Last updated
Mar 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2016

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

Authorized official

Name
Roy L Talley Jr., MDNPI 1396732657
Title
Owner
Phone
(770) 760-9360

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
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1301 Sigman Rd NE
Suite 120
Conyers, GA 30012-3812

Mailing address

PO Box 776
Conyers, GA 30012-0776

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456876800000",
    "number": "1679933774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300120776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 SIGMAN RD NE",
            "address_2": "SUITE 120",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123812",
            "telephone_number": "770-760-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCALIBUR ANESTHESIA ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2016-03-02",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-760-9360",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; 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.