| NPI | 1003470758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY JOHNSON Human Resource Manager 601-948-5572 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2022-04-28 |