Healthcare Provider Details

I. General information

NPI: 1285752600
Provider Name (Legal Business Name): AMY TITUS STUCKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DRIVE SE SUITE 100
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

1 HOSPITAL DRIVE SE SUITE 100
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4464
  • Fax:
Mailing address:
  • Phone: 256-880-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21239
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: