Healthcare Provider Details

I. General information

NPI: 1053968305
Provider Name (Legal Business Name): JAMES ALAN WOOD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

215 KINGS CREST LN
PELHAM AL
35124-2847
US

V. Phone/Fax

Practice location:
  • Phone: 205-783-3000
  • Fax:
Mailing address:
  • Phone: 205-601-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-136937
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: