| NPI | 1649790437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY L. MAYS Fnp 662-655-0456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2023-03-01 |