| NPI | 1700493889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY JACKSON Co Owner, Md 704-997-9745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-10-29 |