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General NPI Number Information
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NPI Number | 1942440169
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Entity Type | Individual
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Provider Name | JEFFREY A STOVALL JR. OD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 1570 OLD ALABAMA RD STE 106
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City | ROSWELL
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State | GA
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Zip | 30076-2108
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Country | US
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Telephone | 770-557-0039
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Fax | 678-623-3108
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Provider Business Mailing Address
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Address Line | 1950 OLD GALLOWS RD STE 520
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City | VIENNA
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State | VA
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Zip | 22182-3970
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1174
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License Number State | GA
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