| NPI | 1366993321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODY MICHELLE MORAN Office Manager 228-265-5945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 21885) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 042354MD) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2021-08-20 |