Individual
JUSTIN TRAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1201 OLD HIGHWAY 49 S STE 2, RICHLAND, MS 39218-9617
(769) 233-8844
Mailing address
1201 OLD HIGHWAY 49 S STE 2, RICHLAND, MS 39218-9617
(769) 233-8844
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000006889
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000006889
BOARD OF CERTIFICATION
—
Enumeration date
08/16/2017
Last updated
08/16/2017
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