| NPI | 1669104402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEAH SMITH Credentialing Manager 901-205-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-11-13 |