Provider Demographics
NPI:1003026345
Name:STUBBLEFIELD, GRAVES CRAWLEY JR (MD)
Entity Type:Individual
Prefix:
First Name:GRAVES
Middle Name:CRAWLEY
Last Name:STUBBLEFIELD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 EASTOVER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6729
Mailing Address - Country:US
Mailing Address - Phone:601-982-7914
Mailing Address - Fax:601-362-8545
Practice Address - Street 1:406 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3039
Practice Address - Country:US
Practice Address - Phone:601-991-1933
Practice Address - Fax:601-978-3844
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05680207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology