| NPI | 1720284946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA B WINGFIELD Owner/Physician 228-864-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 17831) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2023-02-24 |