Healthcare Provider Details

I. General information

NPI: 1902885874
Provider Name (Legal Business Name): ANESTHESIA CONSULTANTS MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR SUITE 700
DOTHAN AL
36301-3030
US

IV. Provider business mailing address

1118 ROSS CLARK CIR STE 700
DOTHAN AL
36301-3030
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-5105
  • Fax: 334-671-5073
Mailing address:
  • Phone: 334-793-5105
  • Fax: 334-671-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BARBARA EDMONSON
Title or Position: PRACTICE MANAGER
Credential: CPC, CPME
Phone: 334-793-5105