| NPI | 1124459136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVA JOYCE COOLEY Credentialling Director 601-909-2539 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS R875464) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2016-09-06 |