| NPI | 1770987638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH KELLUM FREDERICKS Owner 601-939-0361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 11722) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-10-21 |