MEDICARE: LATOYA CALHOUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1700381837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA CALHOUN

Provider Business Mailing Address
First Line	:	126 E COLLEGE AVE
Second Line	:
City	:	HOLLY SPRINGS
State	:	MS
Zip	:	38635-3022
Country	:	US
Telephone Number	:	662-333-1075
Fax Number	:	662-333-1111

Provider Business Practice Location Address
First Line	:	126 E COLLEGE AVE
Second Line	:
City	:	HOLLY SPRINGS
State	:	MS
Zip	:	38635-3022
Country	:	US
Telephone Number	:	662-333-1075
Fax Number	:	662-333-1111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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Directions to “ LATOYA CALHOUN ” Practice Location

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