Individual
LATONYA HAILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
128 DEER RUN RD, HATTIESBURG, MS 39402-6205
(601) 410-5836
Mailing address
1507 HARDY ST, HATTIESBURG, MS 39401-4978
(601) 410-5836
(888) 449-9560
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
MS
261QA0600X
Adult Day Care Clinic/Center
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02671051
—
MS
Enumeration date
08/18/2008
Last updated
07/21/2022
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