Healthcare Provider Details

I. General information

NPI: 1992812606
Provider Name (Legal Business Name): STUART CARL TIESZEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 BROOKWOOD MEDICAL CTR DR POB #311
BIRMINGHAM AL
35209-6898
US

IV. Provider business mailing address

2018 BROOKWOOD MEDICAL CTR DR POB #311
BIRMINGHAM AL
35209-6898
US

V. Phone/Fax

Practice location:
  • Phone: 205-329-7808
  • Fax: 205-329-7807
Mailing address:
  • Phone: 205-329-7805
  • Fax: 205-329-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00012918
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number00012918
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: