| NPI | 1548706922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVIN DAVIS Business Manager 601-874-6324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS 859652) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-02-19 |