Healthcare Provider Details

I. General information

NPI: 1821093790
Provider Name (Legal Business Name): ALFRED W.H. STANLEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 BROOKWOOD MEDICAL CTR DR ACC - SUITE 415
BIRMINGHAM AL
35209-6808
US

IV. Provider business mailing address

2022 BROOKWOOD MEDICAL CTR DR ACC - SUITE 415
BIRMINGHAM AL
35209-6808
US

V. Phone/Fax

Practice location:
  • Phone: 205-250-6964
  • Fax: 205-250-8916
Mailing address:
  • Phone: 205-250-6964
  • Fax: 205-250-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5603
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: