Healthcare Provider Details

I. General information

NPI: 1770080400
Provider Name (Legal Business Name): JOHN STEWART HERNDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDEPENDENCE PLAZA SUITE 900
BIRMINGHAM AL
35209-2643
US

IV. Provider business mailing address

1 INDEPENDENCE PLAZA SUITE 900
BIRMINGHAM AL
35209-2643
US

V. Phone/Fax

Practice location:
  • Phone: 205-271-8000
  • Fax: 205-271-8050
Mailing address:
  • Phone: 205-271-8000
  • Fax: 205-271-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD.38885
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: