Individual
ELISHIA CLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1133 W MAIN ST, TUPELO, MS 38801-3409
(662) 678-1010
Mailing address
1133 W MAIN ST, TUPELO, MS 38801-3409
(662) 871-2966
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
526949
MS
Other
Enumeration date
08/30/2021
Last updated
08/30/2021
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