| NPI | 1174184709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA LAJUANA IVORY FULLER Billing And Credentialing Manager 901-922-5951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-11-27 |