| NPI | 1952907792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHET ALLEN THARPE Physician Owner 601-559-6188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2020-12-08 |