| NPI | 1710553052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT DANIEL BRIDGEWATER Office Adminstrator 601-812-6252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-05-27 |