Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 6889 | MS |
N | 213ES0000X | Sports Medicine | 6889 | MS |
Y | 2251X0800X | Physical Therapist - Orthopedic | 6889 | MS |
NPI | 1053936138 |
---|---|
Provider Name | Sam Jackson Dunnam |
First Address | New Albany, MS 38652-3115 |
Second Address | New Albany, MS 38652-3115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2020 |
Last Update Date | 15/06/2020 |