Provider Demographics
NPI:1881926632
Name:PARAGON ANESTHESIA LLC
Entity type:Organization
Organization Name:PARAGON ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-558-8501
Mailing Address - Street 1:1140 HAMMOND DR NE
Mailing Address - Street 2:BLDG. E, SUITE 40
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5338
Mailing Address - Country:US
Mailing Address - Phone:770-558-8501
Mailing Address - Fax:770-558-8512
Practice Address - Street 1:1140 HAMMOND DR NE
Practice Address - Street 2:BLDG E, SUITE 50
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-558-8501
Practice Address - Fax:770-558-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G706886OtherMEDICARE