MEDICARE: WILLIAM LEE STUTTS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	671	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51506020	OTHER		FEDERAL BLUE CROSS
3	74334	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1306834916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM LEE STUTTS PHD

Provider Business Mailing Address
First Line	:	2127 EXECUTIVE PARK DR
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6041
Country	:	US
Telephone Number	:	334-742-9555
Fax Number	:	334-742-0668

Provider Business Practice Location Address
First Line	:	2127 EXECUTIVE PARK DR
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6041
Country	:	US
Telephone Number	:	334-742-9555
Fax Number	:	334-742-0668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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Directions to “ WILLIAM LEE STUTTS PHD” Practice Location

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