Healthcare Provider Details

I. General information

NPI: 1942238498
Provider Name (Legal Business Name): JEFFERY S MCCOLLUM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE D430B
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-631-3270
  • Fax: 251-631-3273
Mailing address:
  • Phone: 251-631-3270
  • Fax: 251-631-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-025861
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: