Individual
TIMOTHY GILLESPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5500 HIGHWAY 363, MANTACHIE, MS 38855-7197
(662) 282-4335
Mailing address
PO BOX 40, MANTACHIE, MS 38855-0040
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7558
MS
Other
Enumeration date
07/30/2015
Last updated
07/30/2015
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