| NPI | 1417616202 |
|---|---|
| Doing Business As | SOUTHSIDE DIABETES & INTEGRATED CARE |
| Entity Type | Organization |
| Authorized Contact | DANA STALLINGS Owner/CEO 757-659-9903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2024-11-25 |