| NPI | 1396567301 |
|---|---|
| Doing Business As | DIVINITY HEALTHCARE INC |
| Entity Type | Organization |
| Authorized Contact | TRINITY SHARDA JOHNSON Owner 662-848-3656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2024-11-08 |