Healthcare Provider Details

I. General information

NPI: 1962131979
Provider Name (Legal Business Name): DRIVE RIGHT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 CYPRESS PLANTATION DR
OLIVE BRANCH MS
38654-7640
US

IV. Provider business mailing address

3715 CYPRESS PLANTATION DR
OLIVE BRANCH MS
38654-7640
US

V. Phone/Fax

Practice location:
  • Phone: 662-548-6269
  • Fax: 662-796-0230
Mailing address:
  • Phone: 626-253-8959
  • Fax: 662-470-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE ELIZABETH ELLZEY
Title or Position: CEO
Credential:
Phone: 662-548-6269