Provider Demographics
NPI:1972580645
Name:STANSELL, TY K (MD)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:K
Last Name:STANSELL
Suffix:
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0700
Mailing Address - Country:US
Mailing Address - Phone:256-237-8527
Mailing Address - Fax:256-237-0208
Practice Address - Street 1:400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5754
Practice Address - Country:US
Practice Address - Phone:256-237-8527
Practice Address - Fax:256-237-0208
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051077427OtherBCBS
AL000077427Medicaid
AL000077427Medicare ID - Type Unspecified
F33012Medicare UPIN