| NPI | 1265271639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARONDA L BAGWELL Owner 774-209-2372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-01-27 |