| NPI | 1134671787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WOODY SISTRUNK Owner 601-949-6990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: MS 15819) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2019-12-13 |