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WILLIAM ENRIQUE AGUDELO CRNA
>> Nurse Anesthetist, Certified Registered >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1174512602
Individual Registrant: WILLIAM ENRIQUE AGUDELO CRNA
Gender: M
Not Sole Proprietor
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
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
Tel: 478-746-5644 Fax: 478-745-4849
Registration Information:
NPI: 1174512602
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 367500000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered | GA | RN092922 |
| N | 367500000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered | SC | APN2487 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AN1387 | SC | 05 |
