| NPI | 1447799861 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | ERICA MADISON Credentialing Specialist 251-342-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-05-09 |