| NPI | 1487027504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LEE GILLUM Surgical First Assistant 228-343-3044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2015-11-11 |