| NPI | 1417740747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH MITCHELL Authorized Official 270-993-4789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-05-28 |