Provider Demographics
NPI:1417925439
Name:STINSON, ALVIA MACON III (MD)
Entity Type:Individual
Prefix:
First Name:ALVIA
Middle Name:MACON
Last Name:STINSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK E DR
Mailing Address - Street 2:STE 255
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3090
Mailing Address - Fax:205-838-6783
Practice Address - Street 1:48 MEDICAL PARK E DR
Practice Address - Street 2:STE 255
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3090
Practice Address - Fax:205-838-6783
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15898208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
E89477Medicare UPIN
AL51027075Medicare ID - Type Unspecified