| NPI | 1831329887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SUDDUTH BRADHAM Nurse Practitioner 662-647-5816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: MS R865030) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2011-07-06 |