| NPI | 1558693671 |
|---|---|
| Doing Business As | GOLDEN AGE CLINIC |
| Entity Type | Organization |
| Authorized Contact | TABATHA DANIELLE WATKINS Administrator 662-453-6323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2022-01-06 |