| NPI | 1780235564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA EROH Credentialing 931-879-5864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2023-12-21 |