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 |