Provider Demographics
NPI:1225841406
Name:GROVES, DESHAUN
Entity type:Individual
Prefix:
First Name:DESHAUN
Middle Name:
Last Name:GROVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WIGGINS LOOP RD STE C
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-9795
Mailing Address - Country:US
Mailing Address - Phone:601-504-1620
Mailing Address - Fax:
Practice Address - Street 1:211 S VALLEY ST STE B
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4047
Practice Address - Country:US
Practice Address - Phone:601-504-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle