Individual
MR. KEVIN DEWAYNE MAULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
5198 OLD HIGHWAY 11, HATTIESBURG, MS 39402-6222
(601) 264-7232
Mailing address
803 OLD SALT RD, SUMRALL, MS 39482-5901
(601) 758-3759
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0264
MS
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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