| NPI | 1194734913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN RUTLEDGE Billing Manager 601-947-1330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-02-04 |