Healthcare Provider Details

I. General information

NPI: 1295372902
Provider Name (Legal Business Name): STOVALL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 W GEORGETOWN ST
CRYSTAL SPRINGS MS
39059-2778
US

IV. Provider business mailing address

716 W GEORGETOWN ST
CRYSTAL SPRINGS MS
39059-2778
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-7801
  • Fax: 601-892-8883
Mailing address:
  • Phone: 601-892-7801
  • Fax: 601-892-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK STOVALL
Title or Position: OWNER
Credential:
Phone: 601-892-7801