Healthcare Provider Details

I. General information

NPI: 1861927592
Provider Name (Legal Business Name): STEPHEN F ALAYLI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 MEREDYTH DR STE 450
ALBANY GA
31707-0220
US

IV. Provider business mailing address

500 W 3RD AVE STE 101
ALBANY GA
31701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 229-446-1990
  • Fax:
Mailing address:
  • Phone: 229-312-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006867
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00000X
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: