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General NPI Number Information
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NPI Number | 1093068900
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Entity Type | Organization
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Legal Business Name | STEWART H TANKERSLEY, MD, LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 1758 PARK PL SUITE 200
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City | MONTGOMERY
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State | AL
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Zip | 36106-1127
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Country | US
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Telephone | 334-538-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 2432 HAWTHORN DR
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City | MONTGOMERY
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State | AL
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Zip | 36111-1617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | STEWART TANKERSLEY
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Credential |
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Telephone | 334-538-9695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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