Provider Demographics
NPI:1063308047
Name:GATLIN, JEFFREY
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GATLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BOGUE CHITTO RD SW
Mailing Address - Street 2:
Mailing Address - City:BOGUE CHITTO
Mailing Address - State:MS
Mailing Address - Zip Code:39629-5170
Mailing Address - Country:US
Mailing Address - Phone:601-914-9430
Mailing Address - Fax:
Practice Address - Street 1:100 BOGUE CHITTO RD SW
Practice Address - Street 2:
Practice Address - City:BOGUE CHITTO
Practice Address - State:MS
Practice Address - Zip Code:39629-5170
Practice Address - Country:US
Practice Address - Phone:601-914-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy