Individual
MAMIE RUTH WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
440 HOLLY HEDGE DR, MADISON, MS 39110-9636
(601) 521-2392
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10084
MS
104100000X
Social Worker
106285
TX
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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