# GRENADA ANESTHESIOLOGY INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679544183
- **Authorized official:** DR. WALTER TAYLOR JR. MD (CEO)
- **Authorized official phone:** (662) 227-7336

## Contact information

- **Practice address:** 960 AVENT DR, GRENADA, MS 38901-5230
- **Practice address phone:** (662) 227-7336
- **Practice address fax:** (662) 227-7000
- **Mailing address:** PO BOX 235019, MONTGOMERY, AL 36123-5019
- **Mailing address phone:** (334) 279-1450
- **Mailing address fax:** (334) 395-4110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2006
- **Last updated:** 07/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 512G700493 | MEDICARE GROUP \# | MS |