| NPI | 1669175600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS DERAMUS CEO 334-538-9853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QP3300X Clinic/Center, Pain | |
| 261QV0200X Clinic/Center, VA | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-06-15 |