Healthcare Provider Details

I. General information

NPI: 1518728849
Provider Name (Legal Business Name): ELIZABETH BOOKER WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2664 S HARPER RD
CORINTH MS
38834-6723
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-4055
  • Fax:
Mailing address:
  • Phone: 662-287-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM10855
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: