Individual
SUZANNE CHANNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT, MBA
Contact information
Practice address
104 MCAULEY DR, VICKSBURG, MS 39183-2825
(601) 883-6309
Mailing address
2160 S FRONTAGE RD, APT 16A, VICKSBURG, MS 39180-5285
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0262
MS
Other
Enumeration date
03/24/2007
Last updated
07/08/2007
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