| NPI | 1740536036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES N/A WHITE CEO 251-432-4117 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine Adult Medicine | |
| 207QG0300X Family Medicine Geriatric Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2023-08-16 |