| NPI | 1912273814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANITIA W35500263550021 DAVIS Owner 601-355-0026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MS 80207) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2012-03-26 |