| NPI | 1568089993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEAGAN CHASTANT-QUALLS Nurse Practitioner 662-349-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2020-07-01 |