| NPI | 1578296307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE GATSON Credentialing Specialist 601-454-4220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-08 |