| NPI | 1629163332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JACKSON Office Manager 601-664-0204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 15849) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MS 15849) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 48926) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: MS 15849) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-02-27 |