| NPI | 1174861611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD HURST PEACOCK Owner 334-501-8867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 1-092190) |
| Additional Taxonomies | 111NR0400X (Licence: AL AL2129) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-092190) | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2018-05-01 |