| NPI | 1780218289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER C BULLOCK President 662-534-2298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2024-04-08 |