| NPI | 1952902835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASANT H DESAI Admin 228-596-2449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 251B00000X Case Management |
| 261Q00000X Clinic/Center | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-12-16 |