Healthcare Provider Details

I. General information

NPI: 1447239868
Provider Name (Legal Business Name): STACY LYNN SIEGEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 INDEPENDENCE DR SUITE 101
HOMEWOOD AL
35209-8314
US

IV. Provider business mailing address

3415 INDEPENDENCE DR SUITE 101
HOMEWOOD AL
35209-8314
US

V. Phone/Fax

Practice location:
  • Phone: 205-937-3979
  • Fax: 205-871-4646
Mailing address:
  • Phone: 205-937-3979
  • Fax: 833-310-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00020740
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: