| Doctor Name: | PATTY STALLWORTH |
| NPI Number: | 1851746010 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 347C00000X |
| Business Practice Address: | 273 Azalea Rd Bldg 1 Suite 100 Mobile, AL - 366091970 |
| Business Phone Number: | 2516076327 |
| Business Fax Number: | |
| Mailing Address: | 273 Azalea Rd Bldg 1, Suite 100 MOBILE |
| State: | AL |
| Postal Code: | 366091970 |
| Phone Number: | 2516076327 |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2016 |
| NPI Last Update Date: | 04/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 347C00000X |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |