Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Keandrea Bacon

Individual provider Certified Registered Nurse Anesthetist · NPI 1619712676

Keandrea Bacon is a Certified Registered Nurse Anesthetist (CRNA) in Ellenwood, Georgia. Qualified in 2025, 1 year ago. Practices with Grady Memorial Hospital Corporation, a 363-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
1
Licensed in
GA
In the registry since
2024
Specialties on file
2

Practice location Address checks out

120 Whirlaway Dr
Ellenwood, GA 30294-3259
Phone: (404) 444-3887
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence CRNA233963 (GA)
Registered Nurse Taxonomy 163W00000X · Licence RN233963 (GA)

Record details

NPI number1619712676
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 1, 2024
Last updated in NPPESSeptember 23, 2025
Certification dateSeptember 23, 2025
Mailing address120 Whirlaway Dr, Ellenwood, GA 30294-3259

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Grady Memorial Hospital Corporation — 363 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Ellenwood