Individual
TIMOTHY SISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 CARLISLE AVE, SHELBYVILLE, TN 37160-3811
(615) 956-1123
Mailing address
115 CARLISLE AVE, SHELBYVILLE, TN 37160-3811
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1750
AL
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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