Provider Demographics
NPI:1790129021
Name:MYLES, BENITA JOETTA (MD)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:JOETTA
Last Name:MYLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 150
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:SEBASTOPOL
Mailing Address - State:MS
Mailing Address - Zip Code:39359-0150
Mailing Address - Country:US
Mailing Address - Phone:601-625-7403
Mailing Address - Fax:601-625-7404
Practice Address - Street 1:1488 HWY 487
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:SEBASTOPOL
Practice Address - State:MS
Practice Address - Zip Code:39359-0150
Practice Address - Country:US
Practice Address - Phone:601-625-7403
Practice Address - Fax:601-625-7404
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine