| NPI | 1316137300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLIE J HOUSEL Credentialing Specialist 228-865-9898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 09295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS R852805) |
| 2084N0400X Psychiatry & Neurology Neurology | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2011-12-19 |