| NPI | 1073267076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE MICHELLE WILLIS Clinic Manager 337-786-1271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 213E00000X Podiatrist | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-07-19 |