| NPI | 1659041663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRIC EDWARDS Medical Director 662-934-8671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-08-31 |