1669018511 NPI number — MRS. STEPHANIE CULPEPPER STUBBS HAIR LOSS SPECIALIST

Table of content: MRS. STEPHANIE CULPEPPER STUBBS HAIR LOSS SPECIALIST (NPI 1669018511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669018511 NPI number — MRS. STEPHANIE CULPEPPER STUBBS HAIR LOSS SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUBBS
Provider First Name:
STEPHANIE
Provider Middle Name:
CULPEPPER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HAIR LOSS SPECIALIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STUBBS
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
CULPEPPER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
STEPHANIE STUBBS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669018511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 BLOEDEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36784-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-564-0425
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29461 HIGHWAY 43
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36784-5737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-564-0425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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