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General NPI Number Information
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NPI Number | 1023235918
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Entity Type | Individual
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Provider Name | CHARISSE NICOLE STOVALL MD
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 920 STANTON L YOUNG BLVD STE 1140
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5036
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Country | US
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Telephone | 405-271-4351
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Fax | 405-271-8665
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Provider Business Mailing Address
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Address Line | 5641 AUTUMN FLAME DR
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City | BRASELTON
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State | GA
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Zip | 30517-7007
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Country | US
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Telephone | 770-262-2406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 46658
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 001275
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD18393
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License Number State | ME
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