| NPI | 1942754338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA U ANAZIA Administrator 601-249-0013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS AD9666895) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2021-06-11 |