Individual
OTHA ANDRAE ADAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 COUNTY ROAD 3312, ENTERPRISE, MS 39330-9070
(601) 527-2765
Mailing address
9 COUNTY ROAD 3312, ENTERPRISE, MS 39330-9070
(601) 527-2765
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
11/27/2024
Last updated
11/27/2024
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