| NPI | 1952687717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN C. KERLEY Credentialing/Billing Specialist 601-957-7340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 09298) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |