Provider Demographics
NPI:1841536158
Name:HIGHTOWER, MARVIN E
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:E
Last Name:HIGHTOWER
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 1:1215 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3532
Mailing Address - Country:US
Mailing Address - Phone:601-941-1130
Mailing Address - Fax:
Practice Address - Street 1:138 MARKET PL
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2205
Practice Address - Country:US
Practice Address - Phone:601-894-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer