| NPI | 1073069498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY JOHNSON Human Resource Manager 601-948-5572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2022-04-28 |