| NPI | 1932739034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RASHAD N. ALI Chief Executive Officer 601-425-3033 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 347B00000X Bus |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |