| NPI | 1871924167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES C WILEY Owner 251-301-8276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine |
| 208000000X Pediatrics | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2017-04-24 |