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General NPI Number Information
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NPI Number | 1679585970
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Entity Type | Organization
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Legal Business Name | TALLADEGA ANESTHESIOLOGY GROUP PC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 604 STONE AVE
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City | TALLADEGA
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State | AL
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Zip | 35160-2217
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Country | US
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Telephone | 256-362-8111
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Fax | 256-761-4203
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Provider Business Mailing Address
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Address Line | PO BOX 660685
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City | BIRMINGHAM
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State | AL
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Zip | 35266-0685
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Country | US
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Telephone | 205-979-5882
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Fax | 205-979-1248
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUZANE C COOPER
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Credential | M.D
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Telephone | 256-761-4047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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