Individual
BARRY WYN GRANTHAM II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATS
Contact information
Practice address
405 OLD TOWN CIR, BRANDON, MS 39042-3628
(601) 720-7446
Mailing address
405 OLD TOWN CIR, BRANDON, MS 39042-3628
(601) 720-7446
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
MS
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MS
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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