| NPI | 1225172562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALENCIA PATRICE MARTIN Vice President 662-455-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 10298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 10035) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2024-05-22 |