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Organization
TALLADEGA ANESTHESIOLOGY GROUP PC
Active
Organization
TALLADEGA ANESTHESIOLOGY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANE C COOPER M.D (PRESIDENT)
(256) 761-4047
Entity
Organization
Contact information
Practice address
604 STONE AVE, TALLADEGA, AL 35160-2217
(256) 362-8111
(256) 761-4203
Mailing address
PO BOX 660685, BIRMINGHAM, AL 35266-0685
(205) 979-5882
(205) 979-1248
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
NULL
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529801440
—
AL
01
—
CN5627
RR MEDICARE GROUP #
AL
Enumeration date
08/13/2006
Last updated
03/11/2010
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