Individual
JERRY LEE STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3688 VETERANS MEMORIAL DR, 200, HATTIESBURG, MS 39401-8246
(601) 554-7402
(601) 554-7488
Mailing address
3688 VETERANS MEMORIAL DR, 200, HATTIESBURG, MS 39401-8246
(601) 554-7402
(601) 554-7488
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00079
MS
363AM0700X
Medical Physician Assistant
PA9103513
FL
Other
Enumeration date
07/16/2006
Last updated
10/19/2021
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