Healthcare Provider Details

I. General information

NPI: 1194147637
Provider Name (Legal Business Name): FAYETTE MEDICAL CENTER-CRNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 TEMPLE AVE N
FAYETTE AL
35555-1314
US

IV. Provider business mailing address

1653 TEMPLE AVE N
FAYETTE AL
35555-1314
US

V. Phone/Fax

Practice location:
  • Phone: 205-923-5966
  • Fax: 205-932-1260
Mailing address:
  • Phone: 205-923-5966
  • Fax: 205-932-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID HERMAN
Title or Position: VP FINANCE
Credential:
Phone: 205-759-7297