| NPI | 1669256384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNDRICK R. REDDING Owner Authorized 225-449-0102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2024-07-09 |