| NPI | 1669242822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE HUMPHRIES Practice Administrator 601-353-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2025-06-13 |