| NPI | 1649736950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LEE VALENTINE Medical Director 601-286-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2019-02-13 |