Individual
SHANE LEE WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
152 HIGHWAY 7 S, OXFORD, MS 38655-5392
(662) 234-7521
(662) 236-3071
Mailing address
5280 COUNTY ROAD 220, WATER VALLEY, MS 38965-6221
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/26/2019
Last updated
09/26/2019
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