Healthcare Provider Details

I. General information

NPI: 1144423005
Provider Name (Legal Business Name): ALISHA STOCKTON VAUGHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA DENETTE STOCKTON M.D.

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E METRO DR SUITE 102
FLOWOOD MS
39232-4402
US

IV. Provider business mailing address

358 BRIAR VIEW DR
BRANDON MS
39042-8228
US

V. Phone/Fax

Practice location:
  • Phone: 601-992-2292
  • Fax:
Mailing address:
  • Phone: 601-519-9579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20656
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: