MEDICARE: DR. STUART LELAND ATKINSON D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4350	AL

General Provider Information

NPI Number	:	1578676011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART LELAND ATKINSON D.M.D.

Provider Business Mailing Address
First Line	:	2321 JOHN HAWKINS PKWY
Second Line	:	221
City	:	HOOVER
State	:	AL
Zip	:	35244-3540
Country	:	US
Telephone Number	:	205-989-5889
Fax Number	:	205-989-6585

Provider Business Practice Location Address
First Line	:	2321 JOHN HAWKINS PKWY
Second Line	:	221
City	:	HOOVER
State	:	AL
Zip	:	35244-3540
Country	:	US
Telephone Number	:	205-989-5889
Fax Number	:	205-989-6585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/09/2007

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