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General NPI Number Information
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NPI Number | 1841536158
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Entity Type | Individual
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Provider Name | MARVIN E HIGHTOWER
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Gender | Male
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 138 MARKET PL
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City | HAZLEHURST
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State | MS
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Zip | 39083-2205
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Country | US
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Telephone | 601-894-8391
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 MANCHESTER DR
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City | CLINTON
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State | MS
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Zip | 39056-3532
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Country | US
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Telephone | 601-941-1130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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