Individual
SHAWN FAYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
103 MEDICAL PARK, HATTIESBURG, MS 39401-9042
(601) 268-5630
Mailing address
PO BOX 778, PURVIS, MS 39475-0778
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0472
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010702011
NATIONAL ATHLETIC TRAINER'S ASSOCIATION BOARD OF CERTIFICATION (NATABOC)
MS
01
—
1005471
NATIONAL ATHLETIC TRAINER'S ASSOCIATION (NATA)
MS
01
—
AT0472
MISSISSIPPI DEPARTMENT OF HEALTH LICENSURE
MS
Enumeration date
09/28/2009
Last updated
10/20/2020
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