Individual
DR. TONYATTA T HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3136 NORTH STATE STREET, JACKSON, MS 39202
(601) 987-3937
(601) 987-3922
Mailing address
1316 NORTH STATE STREET, JACKSON, MS 39202
(601) 987-3937
(601) 987-3922
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
658
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04771528
—
MS
Enumeration date
08/31/2006
Last updated
07/12/2011
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