Healthcare Provider Details

I. General information

NPI: 1447221833
Provider Name (Legal Business Name): JEREMY BRIAN CUSHING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 GRANDVIEW PKWY STE 500
BIRMINGHAM AL
35243-3412
US

IV. Provider business mailing address

104 INTRACOASTAL DR
MADISON AL
35758-9433
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-3510
  • Fax:
Mailing address:
  • Phone: 256-837-5185
  • Fax: 256-837-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number80765
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9213243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: