| NPI | 1669987723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIA M DUNSON President 601-715-0395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2018-06-27 |