| NPI | 1043413891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUELLA G CHURCHWELL Owner 901-753-2794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2024-05-08 |