NPI | 1255602587 |
---|---|
Entity Type | Organization |
Authorized Contact | TABATHA PERRY Manager, Provider Enrollment 901-478-0954 |
Organization Subpart ? | No |
Primary Taxonomy | 208600000X Surgery |
Additional Taxonomies | 207X00000X Orthopaedic Surgery |
2080P0202X Pediatrics, Pediatric Cardiology | |
207VG0400X Obstetrics & Gynecology, Gynecology | |
Enumeration Date | 2012-01-18 |
Last Update Date | 2025-09-22 |