Individual
SHALISA GAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
608 HIGHWAY 80 E # C, CLINTON, MS 39056-5104
(769) 218-0292
(601) 473-2429
Mailing address
608 HIGHWAY 80 E # C, CLINTON, MS 39056-5104
(769) 218-0292
(601) 473-2429
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/24/2017
Last updated
02/24/2017
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