| NPI | 1427578228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY L JACKSON Sr Dir Prov Enrollment & Onboarding 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-06-27 |