| NPI | 1407920549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE STUART Credentialing Specialist 601-200-4880 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care |
| 208800000X Urology | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 207T00000X Neurological Surgery | |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology | |
| 207Y00000X Otolaryngology | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-11-18 |