| NPI | 1780554881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI BLACKMON Office Manager 850-471-2121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-11-05 |
| Last Update Date | 2025-12-04 |