Provider Demographics
NPI:1972774362
Name:BROOKWOOD PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:BROOKWOOD PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:C
Authorized Official - Last Name:TIESZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-329-7805
Mailing Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:POB SUITE 311
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6898
Mailing Address - Country:US
Mailing Address - Phone:205-329-7805
Mailing Address - Fax:205-329-7806
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:POB SUITE 311
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6898
Practice Address - Country:US
Practice Address - Phone:205-329-7805
Practice Address - Fax:205-329-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00129182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1168112100OtherUS DEPTPARTMENT OF LABOR
ALC75916OtherUPIN