Individual
MRS. ALICIA LACHELLE WALLACE STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1407 S MAIN ST, POPLARVILLE, MS 39470-3369
(601) 795-0659
(601) 795-8639
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 795-0659
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21723
MS
207R00000X
Internal Medicine Physician
PGY.2.TUL-MEDPD
LA
208000000X
Pediatrics Physician
21723
MS
208000000X
Pediatrics Physician
PGY.2.TUL-MEDPD
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03205377
—
MS
Enumeration date
12/24/2007
Last updated
07/20/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us