| NPI | 1659105955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CENTERIA GREEN WOOLFOLK Owner 601-672-9730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2025-12-19 |