| NPI | 1003811639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN ELIZABETH FOURTON Director 469-800-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 00348T) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX 00348T) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX 00348T) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2016-01-21 |