| NPI | 1073679817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA NEWTON JOHNSON Family Nurse Practitioner 601-829-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MS R586986) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2023-03-07 |