Individual
MRS. LORI HARRIS STOCKDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1812 E MAIN ST, DOTHAN, AL 36301-3000
(334) 794-2825
(334) 793-5050
Mailing address
1812 E MAIN ST, DOTHAN, AL 36301-3000
(334) 794-2825
(334) 793-5050
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10004359
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51000527
BLUE CROSS & BLUE SHIELD
AL
01
—
51000528
BLUE CROSS & BLUE SHIELD
AL
01
—
51000529
BLUE CROSS & BLUE SHIELD
AL
Enumeration date
05/15/2006
Last updated
03/05/2018
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