| NPI | 1942057054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN W INGRAM Owner 662-417-4378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-09-26 |