| NPI | 1033560826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY H HOLT Office Adm/Office Mgr 731-427-5581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TN DPM213) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM213) |
| 213ER0200X Podiatrist, Radiology (Licence: TN DPM213) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TN DPM213) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2016-10-04 |