Individual
WYATT WADE TARLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10163 HIGHWAY 21 N, PRESTON, MS 39354-8622
(601) 504-5648
Mailing address
10163 HIGHWAY 21 N, PRESTON, MS 39354-8622
(601) 504-5648
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/03/2024
Last updated
07/03/2024
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