Healthcare Provider Details

I. General information

NPI: 1932193406
Provider Name (Legal Business Name): ANESTHESIA & PAIN MANAGEMENT OF TUSCALOOSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

PO BOX 934370
ATLANTA GA
31193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-7111
  • Fax: 205-343-8549
Mailing address:
  • Phone: 800-897-6169
  • Fax: 800-897-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEISA DEVENNY
Title or Position: PRESIDENT
Credential: MD
Phone: 205-759-7111