Provider Demographics
NPI:1659325306
Name:STEGALL, AVA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:LYNN
Last Name:STEGALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MEDICAL ARTS DR
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-9721
Mailing Address - Country:US
Mailing Address - Phone:662-628-1337
Mailing Address - Fax:662-628-1346
Practice Address - Street 1:112 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-9721
Practice Address - Country:US
Practice Address - Phone:662-628-1337
Practice Address - Fax:662-628-1346
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF04334Medicare UPIN