Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT4513 | MS |
Y | 213ES0000X | Sports Medicine | PT4513 | MS |
NPI | 1467789404 |
---|---|
Provider Name | Mrs. Meredith Gore Warf |
First Address | Jackson, MS 39202-2442 |
Second Address | Jackson, MS 39202-2442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2009 |
Last Update Date | 17/11/2011 |