| NPI | 1487852018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILL FULCHER Adm 601-636-0097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R829001) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2022-05-25 |