Healthcare Provider Details

I. General information

NPI: 1568840684
Provider Name (Legal Business Name): PHYSYNERGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 BELTLINE RD SW
DECATUR AL
35601-5514
US

IV. Provider business mailing address

PO BOX 52404
LAFAYETTE LA
70505-2404
US

V. Phone/Fax

Practice location:
  • Phone: 256-350-2211
  • Fax: 256-270-8937
Mailing address:
  • Phone: 706-860-2701
  • Fax: 706-860-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: TIMOTHY KILLEN ADAMS, JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 256-469-7895