| NPI | 1851806079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELLIE R GRAHAM Credentialing Manager 850-577-0045 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2023-03-28 |