Individual
GREGORY THOMAS STALLWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1430 HWY 4-EAST, HOLLY SPRINGS, MS 38634
(662) 551-3369
(662) 551-3421
Mailing address
1430 HWY 4-EAST, P.O. BOX 6000, HOLLY SPRINGS, MS 38634
(662) 551-3369
(662) 551-3421
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
00578
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116623
—
MS
Enumeration date
09/11/2006
Last updated
07/08/2007
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