Healthcare Provider Details

I. General information

NPI: 1700889763
Provider Name (Legal Business Name): STEPHEN M STAGGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 FRANKLIN RD STE 106
BRENTWOOD TN
37027-5250
US

IV. Provider business mailing address

343 FRANKLIN RD SUITE 106
BRENTWOOD TN
37027-5250
US

V. Phone/Fax

Practice location:
  • Phone: 615-373-1255
  • Fax: 615-371-9040
Mailing address:
  • Phone: 615-373-1255
  • Fax: 615-371-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD24521
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberEL211024
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD17443
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11790
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: