| NPI | 1952163206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A TIMM Medical Director 601-442-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-01-24 |