| NPI | 1154983443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE HAWTHORNE Credentialing COO Rdinator 205-310-8051 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2022-12-02 |