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General NPI Number Information
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NPI Number | 1225841406
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Entity Type | Individual
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Provider Name | DESHAUN GROVES
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Gender | Male
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 211 S VALLEY ST STE B
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City | CARTHAGE
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State | MS
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Zip | 39051-4047
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Country | US
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Telephone | 601-504-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 422 WIGGINS LOOP RD STE C
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City | CARTHAGE
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State | MS
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Zip | 39051-9795
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Country | US
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Telephone | 601-504-1620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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