Individual
BENJAMIN CLARK STOVALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2003 ALICE ST STE A, WAYCROSS, GA 31501-6209
(912) 285-0053
Mailing address
5210 MEADOW WOOD RD, BLACKSHEAR, GA 31516-4473
(912) 281-2619
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4467
GA
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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