Ips of St Mary's LLC

NPI #1033342456 in Kingsland, Georgia

Provider Information

NPI Number: 1033342456
Entity Type: Organization
Organization Name: Ips of St Mary's LLC
Primary Specialty: Anesthesiology
Enumeration Date: Sep 2, 2009
Last Updated: Sep 2, 2009

Practice Location

Address: 88 LINDSEY LN
Address 2: STE B
City: Kingsland
State: Georgia
ZIP Code: 31548-6857
Phone: (912) 673-6896

Authorized Official

Name: CARL R. NOBACK, MD
Title: AUTHORIZED OFFICIAL
Phone: (941) 360-1566

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Anesthetist, Certified Registered	367500000X
Anesthesiology	207L00000X	Primary

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