Provider Demographics
NPI:1720021579
Name:STAGNER, JANIE S (MD)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:S
Last Name:STAGNER
Suffix:
Gender:F
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:PO BOX 59552
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35259-9552
Mailing Address - Country:US
Mailing Address - Phone:205-870-1273
Mailing Address - Fax:205-870-1276
Practice Address - Street 1:3401 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5662
Practice Address - Country:US
Practice Address - Phone:205-870-1273
Practice Address - Fax:205-870-1276
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23598208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009981970Medicaid
AL515-09115OtherBLUE CROSS BLUE SHIELD
AL12-00273OtherUNITED HEALTH CARE
ALH58530Medicare UPIN