Organization
GRENADA ANESTHESIOLOGY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER TAYLOR JR. MD (CEO)
(662) 227-7336
Entity
Organization
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7336
(662) 227-7000
Mailing address
PO BOX 235019, MONTGOMERY, AL 36123-5019
(334) 279-1450
(334) 395-4110
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
512G700493
MEDICARE GROUP #
MS
Enumeration date
02/01/2006
Last updated
07/09/2009
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