| NPI | 1508444837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE MICHAEL FUSSELL Physician 229-405-2470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2022-10-26 |