Healthcare Provider Details

I. General information

NPI: 1669901609
Provider Name (Legal Business Name): ALESIA STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 06/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 DAVID DR NE
BIRMINGHAM AL
35235-1920
US

IV. Provider business mailing address

1924 DAVID DR NE
BIRMINGHAM AL
35235-1920
US

V. Phone/Fax

Practice location:
  • Phone: 205-368-0378
  • Fax: 205-368-0378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number17020958
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: