| NPI | 1942591128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICIA OVERTON DIXON Administrator 601-949-5693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2011-04-22 |