| NPI | 1194968982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONEY L JOHNSON Chief Executive Officer 601-437-3052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |