| NPI | 1285738518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD KIMBROUGH Manager 662-377-4685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2020-08-22 |