Provider Demographics
NPI:1578538013
Name:STEGALL, STEPHANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:STEGALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:929 SPRING CREEK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3964
Mailing Address - Country:US
Mailing Address - Phone:423-892-3400
Mailing Address - Fax:423-892-8266
Practice Address - Street 1:929 SPRING CREEK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3964
Practice Address - Country:US
Practice Address - Phone:423-892-3400
Practice Address - Fax:423-892-8266
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN30169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG67848Medicare UPIN