=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659487403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN E. STALLINGS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1026 N FLOWOOD DR
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-9532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-932-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 321360
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-936-0681
-----------------------------------------------------
Fax | 601-936-0686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 07265
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------