| NPI | 1245424688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE F PHELAN Owner 601-790-7710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MS 80145) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 80145) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2022-02-28 |