Healthcare Provider Details

I. General information

NPI: 1356569305
Provider Name (Legal Business Name): JEFFREY E MCCALL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PEPPERELL PKWY
OPELIKA AL
36801
US

IV. Provider business mailing address

PO BOX 627
AUBURN AL
36831-0627
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-2499
  • Fax: 334-528-2497
Mailing address:
  • Phone: 334-528-2499
  • Fax: 334-528-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-098216
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN201075
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: