| Amanda B Hickerson, CRNA | |
|
1000 Medical Center Blvd, Lawrenceville, GA 30046-0000 | |
| (770) 277-3056 | |
| (855) 204-5244 |
| Full Name | Amanda B Hickerson |
|---|---|
| Gender | Female |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 12 Years |
| Location | 1000 Medical Center Blvd, Lawrenceville, Georgia |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295158541 | NPI | - | NPPES |
| 003143008A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | RN159328 (Georgia) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mak Anesthesia Holdings, Llc | 4284917204 | 169 |
| Mak Anesthesia Georgia, Llc | 7315203718 | 92 |
| Entity Name | American Anesthesiology Associates Of Georgia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1528068673 PECOS PAC ID: 7618934779 Enrollment ID: O20041210000442 |
| Entity Name | Advanced Urology Institute Of Georgia |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073896510 PECOS PAC ID: 1759552607 Enrollment ID: O20110926000393 |
| Entity Name | Advanced Urology Anesthesia, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1215365242 PECOS PAC ID: 8729218417 Enrollment ID: O20140225000485 |
| Entity Name | Mak Anesthesia Holdings, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912452939 PECOS PAC ID: 4284917204 Enrollment ID: O20170216001563 |
| Entity Name | Mak Anesthesia Northside Affiliates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609390103 PECOS PAC ID: 7315203718 Enrollment ID: O20171116002499 |
| Entity Name | Advanced Gynecology Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093296824 PECOS PAC ID: 0143568634 Enrollment ID: O20190207001589 |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda B Hickerson, CRNA Po Box 551420, Fort Lauderdale, FL 33355-1420 Ph: (800) 243-3839 | Amanda B Hickerson, CRNA 1000 Medical Center Blvd, Lawrenceville, GA 30046-0000 Ph: (770) 277-3056 |
John G Bojack, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244 | |
John D Singleton, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244 | |
Mr. Charles Leroy Peacock, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30045 Phone: 678-442-4321 | |
Dr. Souleymane Kabore, DNP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 678-312-1000 | |
Allison Reinecke Hodge, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-963-9905 | |
Jennifer D Del Bagno, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244 | |
Elizabeth A Walker, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 770-277-3056 Fax: 855-204-5244 |