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WILLIAM ENRIQUE AGUDELO CRNA

>> Nurse Anesthetist, Certified Registered >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1174512602

Individual Registrant:
 WILLIAM ENRIQUE AGUDELO CRNA
Gender: M
Not Sole Proprietor

Location and contact information for practice:
380 HOSPITAL DRIVE SUITE 410 MACON, GA 31217-8014 US
Tel: 478-746-5644  Fax: 478-745-4849

Contact information for business:
PO BOX 2564  MACON, GA 31203-2565 US
Tel: 478-746-5644  Fax: 478-745-4849

Registration Information:
NPI: 1174512602
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered
GARN092922
N367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered
SCAPN2487

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
AN1387SC05




HEALTH CARE JOBS GA - Page 1



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