| NPI | 1891080800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEAH MICHELLE SMITH Credentialing Manager 901-205-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 0068091) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2023-11-13 |