| NPI | 1013666403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH MITCHELL Authorized Official 270-993-4789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-05-29 |