Healthcare Provider Details

I. General information

NPI: 1003026345
Provider Name (Legal Business Name): GRAVES CRAWLEY STUBBLEFIELD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 BRIARWOOD DR
JACKSON MS
39206-3039
US

IV. Provider business mailing address

2545 EASTOVER DR
JACKSON MS
39211-6729
US

V. Phone/Fax

Practice location:
  • Phone: 601-991-1933
  • Fax: 601-978-3844
Mailing address:
  • Phone: 601-982-7914
  • Fax: 601-362-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number05680
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: