| NPI | 1407112329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE COLE Credentialing COO Rdinator 251-300-2060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: AL 14295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 14295) |
| 208000000X Pediatrics (Licence: AL 22050) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AL 14295) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-05 |