| NPI | 1205125374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY JACKSON GOOLSBY President 337-312-8234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QX0200X Clinic/Center, Oncology | |
| 332900000X Non-Pharmacy Dispensing Site | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2022-07-21 |