Healthcare Provider Details

I. General information

NPI: 1013353291
Provider Name (Legal Business Name): SOUTH ALABAMA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 S THREE NOTCH ST
ANDALUSIA AL
36420-5325
US

IV. Provider business mailing address

PO BOX 10326
GREENSBORO NC
27404-0326
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-8466
  • Fax:
Mailing address:
  • Phone: 336-852-6525
  • Fax: 336-852-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH R JOHNSON
Title or Position: DIRECTOR
Credential: MD
Phone: 912-338-6511