Provider Demographics
NPI:1932953627
Name:STIDHAM, ABBIGAIL ELIZABETH
Entity Type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:ELIZABETH
Last Name:STIDHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-2015
Mailing Address - Country:US
Mailing Address - Phone:423-608-8060
Mailing Address - Fax:
Practice Address - Street 1:MCKNIGHT BRAIN INSTITUTE (L3-100) 1149 NEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-273-5549
Practice Address - Fax:352-273-5575
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC------------------2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology