Healthcare Provider Details

I. General information

NPI: 1992325740
Provider Name (Legal Business Name): CASEY CHRISTOPHER STANFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5192 MAIN ST
LUCEDALE MS
39452-6771
US

IV. Provider business mailing address

5192 MAIN ST
LUCEDALE MS
39452-6771
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-0250
  • Fax: 601-947-0103
Mailing address:
  • Phone: 601-947-0250
  • Fax: 601-947-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29424
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: