Individual
DR. ERICA R BALTHROP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
401 SOUTHCREST CIR STE 104, SOUTHAVEN, MS 38671-6712
(662) 349-1112
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5827
(901) 226-3186
(901) 226-3160
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
16812
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122260
—
MS
01
—
149982001
ARK MEDICAID
MS
01
—
82606
ARK BC BS
MS
Enumeration date
09/21/2005
Last updated
10/23/2024
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