Individual
TAIT CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
118 COLLEGE DR, HATTIESBURG, MS 39406-0001
(601) 266-5104
Mailing address
117 SOUTHERN HILLS DR, HATTIESBURG, MS 39401-5829
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0923
MS
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/07/2017
Last updated
08/30/2020
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