Healthcare Provider Details

I. General information

NPI: 1023069291
Provider Name (Legal Business Name): SHELBY ANESTHESIOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GROVER ST
SHELBY NC
28150-3917
US

IV. Provider business mailing address

PO BOX 890561
CHARLOTTE NC
28289-0561
US

V. Phone/Fax

Practice location:
  • Phone: 704-487-3000
  • Fax: 706-737-2272
Mailing address:
  • Phone: 800-919-1190
  • Fax: 706-737-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILSON FARRIS SURRATT
Title or Position: PRESIDENT
Credential: MD
Phone: 704-482-5716