Provider Demographics
NPI:1184120644
Name:FOXWORTH, RASHAN
Entity type:Individual
Prefix:
First Name:RASHAN
Middle Name:
Last Name:FOXWORTH
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 1:192 FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-8111
Mailing Address - Country:US
Mailing Address - Phone:601-731-8689
Mailing Address - Fax:
Practice Address - Street 1:192 FRIENDSHIP CHURCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-8111
Practice Address - Country:US
Practice Address - Phone:601-731-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801668841172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver