| NPI | 1043239916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND JOHNSON Director 601-867-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: MS BOS-BMR) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-22 |