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General NPI Number Information
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NPI Number | 1770767030
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Entity Type | Individual
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Provider Name | MRS. LETHA DEMETRA WARREN
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Gender | Female
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 306 S HIGH SCHOOL AVE
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City | COLUMBIA
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State | MS
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Zip | 39429-3414
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Country | US
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Telephone | 601-736-1448
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Fax | 601-736-6067
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Provider Business Mailing Address
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Address Line | 306 S HIGH SCHOOL AVE
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City | COLUMBIA
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State | MS
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Zip | 39429-3414
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Country | US
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Telephone | 601-736-4035
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Fax | 601-736-4037
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 343900000X
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 376J00000X
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 385H00000X
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License Number State | MS
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