| NPI | 1679257703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY TAZAMEAR SMITH Owner 601-549-0710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 291U00000X Clinical Medical Laboratory | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2023-06-11 |