| NPI | 1730130345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM M HUMPHREY Provider/President 931-528-2443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD6278) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-09-17 |