Healthcare Provider Details

I. General information

NPI: 1912974254
Provider Name (Legal Business Name): JOHN R. SLAYTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 TAYLOR RD
MONTGOMERY AL
36117-3563
US

IV. Provider business mailing address

2151 OLD ROCKY RIDGE ROAD SUITE 106
BIRMINGHAM AL
35216-7251
US

V. Phone/Fax

Practice location:
  • Phone: 334-226-4048
  • Fax: 334-323-5675
Mailing address:
  • Phone: 205-989-1080
  • Fax: 205-989-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-033082
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: