| NPI | 1558123190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC A HULTQUIST CEO 256-258-8319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Additional Taxonomies | 208000000X Pediatrics |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QP2300X Clinic/Center, Primary Care | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-02-23 |