| NPI | 1407459027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA SUTHERLAND Provider Enrollment 229-891-9131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2023-07-28 |