Individual
JACKSON RANDALL THERRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
224 CROWS NEST CIR, DECATUR, MS 39327-9186
(601) 678-6199
Mailing address
224 CROWS NEST CIR, DECATUR, MS 39327-9186
(601) 678-6199
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0792
MS
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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