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General NPI Number Information
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NPI Number | 1326914474
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Entity Type | Individual
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Provider Name | GLENDA FAE MILAM
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 6229 MISSISSIPPI 305 STE A#168
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City | OLIVE BRANCH
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State | MS
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Zip | 38654
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Country | US
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Telephone | 662-550-1213
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Fax |
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Provider Business Mailing Address
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Address Line | 2546 SHELBURNE LN E
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6330
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Country | US
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Telephone | 662-550-1213
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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 | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State | MS
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