Provider Demographics
NPI:1023653839
Name:STOVALL, FRANK
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:STOVALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 W GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2778
Mailing Address - Country:US
Mailing Address - Phone:601-892-7801
Mailing Address - Fax:601-892-8883
Practice Address - Street 1:716 W GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2778
Practice Address - Country:US
Practice Address - Phone:601-892-7801
Practice Address - Fax:601-892-8883
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver