| NPI | 1104137439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EUGENE THOMAS Owner 256-241-2671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AL 1084368) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 14173) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2014-07-02 |