Individual
SHUWANDA NICOLE GATLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
69 GINNTOWN RD, TYLERTOWN, MS 39667-5597
(601) 876-8779
Mailing address
PO BOX 511, TYLERTOWN, MS 39667-0511
(601) 876-8779
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
920882044
—
MS
Enumeration date
12/26/2022
Last updated
12/26/2023
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