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NPI Code Detail

MEDICARE: JOHNNY DALE STACKHOUSE DO

MEDICARE: JOHNNY DALE STACKHOUSE DO
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
1207Q00000XFamily Medicine PhysicianDO.1476AL

General Provider Information

NPI Number : 1952569626
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY DALE STACKHOUSE DO
Provider Business Mailing Address
First Line : 910 S DONAHUE DR
Second Line :
City : AUBURN
State : AL
Zip : 36832-2975
Country : US
Telephone Number : 334-442-4012
Fax Number :
Provider Business Practice Location Address
First Line : 910 S DONAHUE DR
Second Line :
City : AUBURN
State : AL
Zip : 36832-2975
Country : US
Telephone Number : 334-442-4012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2008
Last Update Date : 07/14/2016

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Directions to “ JOHNNY DALE STACKHOUSE DO” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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