Healthcare Provider Details

I. General information

NPI: 1114247319
Provider Name (Legal Business Name): CHRISTINA RENEE STALLWORTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W RANDOL MILL RD
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

14275 MIDWAY RD STE 400
ADDISON TX
75001-3676
US

V. Phone/Fax

Practice location:
  • Phone: 817-960-6225
  • Fax: 817-960-6519
Mailing address:
  • Phone: 972-934-4300
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberE-9244
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE-9244
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: