Healthcare Provider Details

I. General information

NPI: 1063471761
Provider Name (Legal Business Name): STEPHEN T AMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 GARFIELD ST STE 201
TUPELO MS
38801-6301
US

IV. Provider business mailing address

ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 662-680-5565
  • Fax:
Mailing address:
  • Phone: 662-680-5565
  • Fax: 662-680-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME57925
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number16359
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: