| NPI | 1346544376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD JAMES BLACKWOOD President 662-843-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R855837) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |