Healthcare Provider Details

I. General information

NPI: 1699035782
Provider Name (Legal Business Name): LAURA JENELLE STABIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR RD
MONTGOMERY AL
36117
US

IV. Provider business mailing address

8601 HARVEST RIDGE DR
MONTGOMERY AL
36116-6668
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-8330
  • Fax:
Mailing address:
  • Phone: 615-300-9689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD.36952
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01095593A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC3567
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC3567
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: