| NPI | 1144786948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARSHA CARTER AMBEAU Manager 601-304-2043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-02-16 |
| Last Update Date | 2019-02-16 |