Individual
ROY BENNETT FONTENOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
283 DEBUYS RD, GULFPORT, MS 39507-2800
(228) 731-3500
Mailing address
2704 BULLIS AVE, GULFPORT, MS 39501-5231
(228) 223-5250
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/17/2023
Last updated
01/17/2023
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