Individual
DAVIS THOMAS FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 562-7119
Mailing address
12631 ROAD 759, PHILADELPHIA, MS 39350-6930
(601) 562-7119
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0290
MS
Other
Enumeration date
08/12/2022
Last updated
08/12/2022
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