Healthcare Provider Details

I. General information

NPI: 1720021579
Provider Name (Legal Business Name): JANIE S. STAGNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 INDEPENDENCE DR
BIRMINGHAM AL
35209-5662
US

IV. Provider business mailing address

PO BOX 59552
BIRMINGHAM AL
35259-9552
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-1273
  • Fax: 205-870-1276
Mailing address:
  • Phone: 205-870-1273
  • Fax: 205-870-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23598
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: