Provider Demographics
NPI:1154413383
Name:STEVENSON, ALAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 MEMORIAL MEDICAL CT SUITE 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4455
Mailing Address - Country:US
Mailing Address - Phone:864-295-3492
Mailing Address - Fax:864-295-4817
Practice Address - Street 1:8 MEMORIAL MEDICAL CT SUITE 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4455
Practice Address - Country:US
Practice Address - Phone:864-295-3492
Practice Address - Fax:864-295-4817
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86688207ZH0000X, 207ZP0102X
TN40220207ZP0102X
GA047665207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10054286OtherAMERIGROUP GA MEDICAIDCMO
NC5902738Medicaid
AL009934501Medicaid
TN000000036657OtherTLC TENNCARE
GA000841981GMedicaid
GA000841981HMedicaid
TN100049673OtherPHP TENNCARE
GA335783OtherWELLCARE GA MEDICAID CMO
TN3334229Medicaid
TN4115257OtherBLUE CROSS
KY64114622Medicaid
TN173844OtherUNISON TENNCARE
GA000841981HMedicaid
GA000841981GMedicaid