| NPI | 1639764020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEONTRANESE TAYLOR Nurse Practitioner 601-754-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-04-27 |