| NPI | 1083255087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONEY LEE JOHNSON Chief Operating Officer 601-425-3033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2020-01-17 |