| NPI | 1639938418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HURST Credentialing Manager 501-773-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2024-03-15 |