Most Relevant Information
Provider Data
| NPI Number: | 1003505843 |
| Provider Name: | SAMANTHA AYERS |
| Entity Type: | Individual |
| Taxonomy Code: | 305S00000X |
| Specialty: | Point of Service |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/08/2023 |
| Last Updated: | 05/08/2023 |
Provider Practice Location
1120 MAIN ST
SOUTHAVEN
MS
386711428
Practice Location Phone/Fax
| Phone: | 9018463092 |
| Fax: |
Provider Mailing Location
4904 RICHARD PLACE CV
HORN LAKE
MS
386379601
Provider Mailing Phone/Fax
| Phone: | 9018463092 |
| Fax: |