Provider Demographics
NPI:1851488514
Name:STOKLEY, CHARLES TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TODD
Last Name:STOKLEY
Suffix:
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 1:940 MATTHEW DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367
Mailing Address - Country:US
Mailing Address - Phone:601-671-8555
Mailing Address - Fax:601-671-0777
Practice Address - Street 1:940 MATTHEW DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367
Practice Address - Country:US
Practice Address - Phone:601-671-8555
Practice Address - Fax:601-671-0777
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00964OtherAL BCBS
279588OtherTRICARE
MS0113843Medicaid
F85485Medicare UPIN