=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992826325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRAWAY SURGICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 CARRAWAY BLVD PHYSICIAN PLAZA SUITE 200
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35234-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-502-3600
-----------------------------------------------------
Fax | 205-502-3601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 CARRAWAY BLVD PHYSICIAN PLAZA SUITE 200
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35234-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-502-3600
-----------------------------------------------------
Fax | 205-502-3601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. BRENDA J BURNETTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-502-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 6354
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------