NPIMap

Organization Active NPI

Blue Water Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Snellville, GA
National Provider Identifier
1801291646
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN191954 Issued in GA
Legal business name
BLUE WATER ANESTHESIA, LLC
Practice address
2175 North Rd
Snellville, GA 30078-2630
Phone
(770) 979-0900
Fax
(770) 979-2852
NPI assigned
Oct 22, 2014
Last updated
Jan 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Authorized official

Name
Mr. Bruce Gaynes
Title
Registered Agent
Phone
(404) 467-7526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN191954 GA Primary

Addresses

Primary practice location

2175 North Rd
Snellville, GA 30078-2630

Mailing address

PO Box 700
Snellville, GA 30078-0700
Phone (770) 979-0900

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1801291646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300780700",
            "telephone_number": "770-979-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 NORTH RD",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782630",
            "telephone_number": "770-979-0900",
            "fax_number": "770-979-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "GAYNES",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "404-467-7526",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN191954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.