| NPI | 1619403870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERMARIA JACKSON Practice Manager 901-878-3274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-08-30 |