Provider Demographics
NPI:1124150164
Name:STILES, MARIA A (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:STILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:A
Other - Last Name:MASSANET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:302 MACON DR SE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2659
Mailing Address - Country:US
Mailing Address - Phone:205-933-8101
Mailing Address - Fax:256-413-7813
Practice Address - Street 1:206 RESCIA AVE
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5933
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:256-413-7813
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12549261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12549OtherMEDICAL LICENSE