| NPI | 1285818005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN DURR Office Manager 601-856-9980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 12039) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MS 12039) |
| 207Q00000X Family Medicine (Licence: MS 10806) | |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2011-12-29 |