Healthcare Provider Details

I. General information

NPI: 1679585970
Provider Name (Legal Business Name): TALLADEGA ANESTHESIOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 STONE AVE
TALLADEGA AL
35160-2217
US

IV. Provider business mailing address

PO BOX 660685
BIRMINGHAM AL
35266-0685
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-8111
  • Fax: 256-761-4203
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SUZANE C COOPER
Title or Position: PRESIDENT
Credential: M.D
Phone: 256-761-4047