| NPI | 1104793454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADISON DAVIS Credentialing Assistant 442-325-8753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2025-10-21 |
| Last Update Date | 2025-10-21 |