| NPI | 1598348799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD GREGORY TISDALE Nurse Practitioner 228-669-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-05-28 |