| NPI | 1518281864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEAH MICHELLE SMITH Credentialing Manager 901-205-3999 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: GA 5765) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2023-11-13 |