| NPI | 1003301300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEQUEENA SMITH Credentialing 704-493-5326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2024-07-31 |