Individual
MS. TELITHA K GRANT-SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1488 HWY 487, SEBASTOPOL, MS 39359-0150
(601) 625-7403
(601) 625-7404
Mailing address
PO BOX 150, SEBASTOPOL, MS 39359-0150
(601) 625-7403
(601) 625-7404
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24502
MS
207R00000X
Internal Medicine Physician
MD.200333
LA
208000000X
Pediatrics Physician
24502
MS
208000000X
Pediatrics Physician
MD.200333
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00656244
—
MS
05
—
1069973
—
LA
Enumeration date
10/24/2007
Last updated
04/30/2025
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