| NPI | 1942965306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYDNI CLEMMONS Credentialing Manager 931-253-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center Rural Health |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2022-09-19 |