| NPI | 1093929184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THAD R. JACKSON Physician And Owner 270-769-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2009-01-13 |