Individual
MR. RJAI DE RICO GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA CSS
Contact information
Practice address
428 24TH AVE N, COLUMBUS, MS 39705-1945
(662) 241-7097
(662) 245-0511
Mailing address
428 24TH AVE N, COLUMBUS, MS 39705-1945
(662) 241-7097
(662) 245-0511
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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