Provider Demographics
NPI:1366222176
Name:POSS, DEXTER CICERO (CRNA)
Entity type:Individual
Prefix:
First Name:DEXTER
Middle Name:CICERO
Last Name:POSS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 RANDOLPH STILL RD
Mailing Address - Street 2:
Mailing Address - City:GOOD HOPE
Mailing Address - State:GA
Mailing Address - Zip Code:30641-2136
Mailing Address - Country:US
Mailing Address - Phone:706-284-4159
Mailing Address - Fax:
Practice Address - Street 1:5126 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2566
Practice Address - Country:US
Practice Address - Phone:770-786-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279327367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered