| NPI | 1396709283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN STUBBLEFIELD Assistant Business Manager 731-642-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207Q00000X Family Medicine | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 0000005352) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2008-09-12 |