| NPI | 1730467648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABBY HAVARD Assistant Ad/Health & Perfromance 662-846-4280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2021-10-04 |