| NPI | 1801571823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LOTT Provider Enrollment Manager 251-434-3984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 207R00000X Internal Medicine | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 208000000X Pediatrics | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 2085R0001X Radiology, Radiation Oncology | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 208600000X Surgery | |
| 208M00000X Hospitalist | |
| 213E00000X Podiatrist | |
| 231H00000X Audiologist | |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-12-26 |