Healthcare Provider Details

I. General information

NPI: 1407911787
Provider Name (Legal Business Name): KMKG ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8907
US

IV. Provider business mailing address

PO BOX 1427
JASPER AL
35502-1427
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4741
  • Fax: 205-221-5474
Mailing address:
  • Phone: 205-221-5454
  • Fax: 205-221-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateAL

VIII. Authorized Official

Name: GARY KEITH MORTON
Title or Position: PRESIDENT
Credential: MD
Phone: 205-387-4741