| NPI | 1386676153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE T BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2011-06-24 |