Healthcare Provider Details

I. General information

NPI: 1003844671
Provider Name (Legal Business Name): MERRILEE BURG COBY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH STREET S
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4011
  • Fax: 205-297-9411
Mailing address:
  • Phone: 205-731-9701
  • Fax: 205-989-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-079789
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: