Healthcare Provider Details

I. General information

NPI: 1609947274
Provider Name (Legal Business Name): ALISON SEWELL BRIGHAM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST ROOM 2144
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

PO BOX 204097
AUGUSTA GA
30917-4097
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3873
  • Fax: 706-721-7763
Mailing address:
  • Phone: 762-224-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN135152
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: