Individual
TRYSTAN JAMES SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1541
(229) 257-2778
Mailing address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
10/16/2024
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