Healthcare Provider Details

I. General information

NPI: 1730626482
Provider Name (Legal Business Name): TAYLOR J WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

PO BOX 1427
JASPER AL
35502-1427
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4000
  • Fax:
Mailing address:
  • Phone: 888-316-7491
  • Fax: 888-316-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-127948
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: