Individual
GARRETT HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 NORTHBAY DR, MADISON, MS 39110-8859
(662) 213-9099
Mailing address
402 NORTHBAY DR, MADISON, MS 39110-8859
(662) 213-9099
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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