Provider Demographics
NPI:1992826325
Name:CARRAWAY SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:CARRAWAY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-502-3600
Mailing Address - Street 1:1600 CARRAWAY BLVD
Mailing Address - Street 2:PHYSICIAN PLAZA SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35234-1913
Mailing Address - Country:US
Mailing Address - Phone:205-502-3600
Mailing Address - Fax:205-502-3601
Practice Address - Street 1:1600 CARRAWAY BLVD
Practice Address - Street 2:PHYSICIAN PLAZA SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234-1913
Practice Address - Country:US
Practice Address - Phone:205-502-3600
Practice Address - Fax:205-502-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C14180Medicare UPIN
AL51098498Medicare ID - Type Unspecified