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General NPI Number Information
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NPI Number | 1396234498
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Entity Type | Individual
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Provider Name | DEBORAH LATRICE PRIDE
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Gender | Female
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 4365 HIGHWAY 51 S
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City | SENATOBIA
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State | MS
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Zip | 38668-2533
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Country | US
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Telephone | 662-562-3049
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Fax | 877-855-7540
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Provider Business Mailing Address
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Address Line | 4365 HIGHWAY 51 S
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City | SENATOBIA
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State | MS
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Zip | 38668-2533
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Country | US
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Telephone | 662-562-3049
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Fax | 877-855-7540
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 800280913
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License Number State | MS
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