| NPI | 1013021021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS JEAN CANNON Office Mananger 334-664-0219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00017633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 037931) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-08-22 |