Healthcare Provider Details

I. General information

NPI: 1063863082
Provider Name (Legal Business Name): ANDREW HORNSBY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 RIVER CHASE DR
PHENIX CITY AL
36867-7483
US

IV. Provider business mailing address

78 LEE ROAD 2134
SMITHS STATION AL
36877-3279
US

V. Phone/Fax

Practice location:
  • Phone: 334-732-3969
  • Fax: 334-732-3646
Mailing address:
  • Phone: 205-613-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-131017
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: