| NPI | 1679365001 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | DANIEL SIMMONS CEO 229-888-7420  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care | 
| Additional Taxonomies | 207Q00000X Family Medicine | 
| Enumeration Date | 2025-05-21 | 
| Last Update Date | 2025-09-15 |