| NPI | 1326710526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY LONDON TYUS Owner 229-220-7755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363L00000X Nurse Practitioner | |
| 171400000X Health & Wellness Coach | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-10-05 |