Healthcare Provider Details

I. General information

NPI: 1043281553
Provider Name (Legal Business Name): MONTGOMERY ANESTHESIA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/02/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PINE ST
MONTGOMERY AL
36106-1109
US

IV. Provider business mailing address

PO BOX 106090
ATLANTA GA
30348-6090
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8059
  • Fax:
Mailing address:
  • Phone: 334-513-1173
  • Fax: 855-999-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DOLES
Title or Position: PRESIDENT
Credential: MD
Phone: 334-293-8008