| NPI | 1336866615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHINITA REED DUDLEY Owner 601-213-7681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2023-01-31 |