| NPI | 1942392717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY M PERRY Rph 601-355-2438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 01086/01.1) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-08-22 |