Individual
EDWARD N GATLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ETC
Contact information
Practice address
20 OTIS LN, FOXWORTH, MS 39483-3102
(601) 467-0848
Mailing address
20 OTIS LN, FOXWORTH, MS 39483-3102
(601) 467-0848
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
801615243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
801615243
DRIVER LICENSE
MS
01
—
832-374-5638
TAX EIN NUMBER
MS
Enumeration date
12/07/2018
Last updated
12/07/2018
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