Individual
DARA E MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
507 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2334
(601) 835-0842
Mailing address
2625 HEUCKS RETREAT RD NE, WESSON, MS 39191-9467
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0441
MS
Other
Enumeration date
06/17/2013
Last updated
06/17/2013
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