| NPI | 1225433436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE JACKSON Nurse Practitioner 601-859-0140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS R862558) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2014-12-31 |