Organization
FAYETTE MEDICAL CENTER-CRNA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HERMAN (VP FINANCE)
(205) 759-7297
Entity
Organization
Contact information
Practice address
1653 TEMPLE AVE N, FAYETTE, AL 35555-1314
(205) 923-5966
(205) 932-1260
Mailing address
1653 TEMPLE AVE N, FAYETTE, AL 35555-1314
(205) 923-5966
(205) 932-1260
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102G704766
MEDICARE ID
AL
Enumeration date
01/17/2014
Last updated
07/02/2026
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