Provider Demographics
NPI:1346612009
Name:STELLAR AMBULATORY ANESTHESIA CONSULTANTS, LLC
Entity type:Organization
Organization Name:STELLAR AMBULATORY ANESTHESIA CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-230-7914
Mailing Address - Street 1:3254 TWISTED BRANCHES LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2479
Mailing Address - Country:US
Mailing Address - Phone:770-516-1775
Mailing Address - Fax:770-516-8768
Practice Address - Street 1:1150 HAMMOND DR
Practice Address - Street 2:BLDG E, SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:770-516-1775
Practice Address - Fax:770-516-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty