NPI | 1700354453 |
---|---|
Entity Type | Organization |
Authorized Contact | TYRONE LUSTER Owner 901-626-2129 |
Organization Subpart ? | Yes |
Primary Taxonomy | 208D00000X General Practice |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2018-11-09 |
Last Update Date | 2018-11-09 |