| NPI | 1154549707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA FAYE THOMAS Physicain 601-981-7198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 13653) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 18905) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2010-12-09 |