| NPI | 1104409937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA DAWN MEREDITH Manager 276-613-0745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2021-07-19 |