=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356787378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN JULIAN STUCKEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2013
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 BEVERLY DR STE 141
-----------------------------------------------------
City | CALERA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35040-5658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-651-0345
-----------------------------------------------------
Fax | 205-651-0324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 BEVERLY DR STE 141
-----------------------------------------------------
City | CALERA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35040-5658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-651-0345
-----------------------------------------------------
Fax | 205-651-0324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.35378
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------