Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT5296 | MS |
NPI | 1013401017 |
---|---|
Provider Name | Brittany Latay Mcclendon Spivey |
First Address | Forest, MS 39074-3315 |
Second Address | Forest, MS 39074-8829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2018 |
Last Update Date | 23/10/2018 |