| NPI | 1801431499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY VILLANUEVA President 901-818-3921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-15 |