| NPI | 1255738035 |
|---|---|
| Doing Business As | FONDREN CARE CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN CHAD GIBSON Office Manager 601-951-9197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 07980) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS R860365) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS R878138) | |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: MS R860365) | |
| Enumeration Date | 2014-11-22 |
| Last Update Date | 2014-11-22 |