# TALLADEGA ANESTHESIOLOGY GROUP PC

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

## Provider details

- **NPI number:** 1679585970
- **Authorized official:** SUZANE C COOPER M.D (PRESIDENT)
- **Authorized official phone:** (256) 761-4047

## Contact information

- **Practice address:** 604 STONE AVE, TALLADEGA, AL 35160-2217
- **Practice address phone:** (256) 362-8111
- **Practice address fax:** (256) 761-4203
- **Mailing address:** PO BOX 660685, BIRMINGHAM, AL 35266-0685
- **Mailing address phone:** (205) 979-5882
- **Mailing address fax:** (205) 979-1248

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 08/13/2006
- **Last updated:** 03/11/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 529801440 | — | AL |
| 01 | — | CN5627 | RR MEDICARE GROUP \# | AL |