| NPI | 1043097421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI LYNN GIBBS Owner 601-692-8997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2023-09-11 |