| NPI | 1821103920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY QUINN Owner/President 601-487-6482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-09-10 |