1982869681 NPI number — SHUNTA C. TAYLOR-GETER CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982869681 NPI number — SHUNTA C. TAYLOR-GETER CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TAYLOR-GETER

Provider First Name:

SHUNTA

Provider Middle Name:

C.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1982869681

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/19/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 11407

Provider Second Line Business Mailing Address:

ATTN: DEPT 1717

Provider Business Mailing Address City Name:

BIRMINGHAM

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35246-0100

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-979-5882

Provider Business Mailing Address Fax Number:

205-979-1248

Provider First Line Business Practice Location Address:

619 19TH ST S

Provider Second Line Business Practice Location Address:

ROOM JT845

Provider Business Practice Location Address City Name:

BIRMINGHAM

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

35249-1900

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

205-934-7072

Provider Business Practice Location Address Fax Number:

205-975-5963

Provider Enumeration Date:

07/22/2008

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 163W00000X , with the licence number:  RN143629 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: APN13625 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 1-137540 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: RN184462 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 8053564 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: P00747429 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 427087670A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110677 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: N475530 . This is a "WELLCARE (GA MEDICAID)" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 4194916 . This is a "BLUE CROSS BLUE SHIELD OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 1513123 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".