Healthcare Provider Details

I. General information

NPI: 1982613683
Provider Name (Legal Business Name): MYRON CORNEL STOKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 CULLY RD
CORDOVA TN
38018-8502
US

IV. Provider business mailing address

PO BOX 1562
COLLIERVILLE TN
38027-1562
US

V. Phone/Fax

Practice location:
  • Phone: 615-484-8128
  • Fax: 901-328-5599
Mailing address:
  • Phone: 901-316-5648
  • Fax: 901-221-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number21733
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21733
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: