Provider Demographics
NPI:1942231386
Name:CURTIS, CARLETON LYNCH (CRNA)
Entity Type:Individual
Prefix:
First Name:CARLETON
Middle Name:LYNCH
Last Name:CURTIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARLETON
Other - Middle Name:LYNCH
Other - Last Name:GOFORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2151 OLD ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6101
Mailing Address - Country:US
Mailing Address - Phone:205-989-1080
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-989-1080
Practice Address - Fax:205-989-1087
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095612367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-33041OtherBC&BS OF ALABAMA
AL051557467Medicaid
AL051557467GOFMedicare ID - Type Unspecified
ALQ67242Medicare UPIN