| NPI | 1386301059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY JOHNSON Human Resource Manager 601-948-5572 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2021-11-17 |