Individual
EBONY WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
811 MAIN ST STE 17, COLUMBIA, MS 39429-2711
(601) 549-3006
Mailing address
102 LEXINGTON DR, HATTIESBURG, MS 39402-9313
(601) 549-3006
(601) 549-3006
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
Z6Y4T5D7
MS
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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