Healthcare Provider Details

I. General information

NPI: 1619437761
Provider Name (Legal Business Name): CHANDLER SCOTT STISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MAIN ST
GRANT AL
35747-8303
US

IV. Provider business mailing address

301 GOVERNORS DRIVE SW
HUNTSVILLE AL
35801-5123
US

V. Phone/Fax

Practice location:
  • Phone: 256-728-8600
  • Fax:
Mailing address:
  • Phone: 256-551-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.41399
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: